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From the 10/15/2021 release of VAERS data:

Found 17,128 cases where Vaccine is COVID19 and Patient Died



Case Details (Reverse Sorted by Onset Date)

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VAERS ID: 1782301 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-08
Onset:2021-10-13
   Days after vaccination:247
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EJ1686 / 2 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 1785065 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-03-08
Onset:2021-10-13
   Days after vaccination:219
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Agitation, Bacterial infection, Blood sodium decreased, Brain natriuretic peptide normal, COVID-19, COVID-19 pneumonia, Cardiac arrest, Cardio-respiratory arrest, Chest X-ray normal, Constipation, Death, Dyspnoea, Endotracheal intubation, Full blood count abnormal, Intensive care, Leukocytosis, Life support, Lipase normal, Mechanical ventilation, Nausea, Polyuria, Pulseless electrical activity, Respiratory failure, Resuscitation, Superinfection, Troponin normal, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic leukopenia (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: From H&P: "Patient is a 72 y.o. male who presented to the emergency department due to shortness of breath. According the patient symptoms started after he was diagnosed with Covid 19 on 9/29. Reports initially was mild shortness of breath but progressed to severe thus presented to the emergency department for evaluation. The patient reports symptoms were associated with mild epigastric pain and nausea. Reports constipation. Denies chest pain, fever, chills, hemoptysis, lower extremity edema, orthopnea. Evaluation emergency department included chest x-ray which was negative. CBC revealed mild leukocytosis with white count 12.7. Sodium is 131. Lipase was normal. BNP was normal in trop was negative. With ambulation the patient required 2 L nasal cannula thus admission was requested. Upon evaluation patient continues report shortness of breath. He continues to deny pertinent negatives outlined above. Does not appear to be in acute distress." Hospital Course: The patient was admitted to Hospital COVID-19 medical unit for hypoxic respiratory failure secondary to COVID-19 viral pneumonia on 10/04/2021. He reportedly received the Jansen vaccine, single dose March 2021. Upon admission he was started on dexamethasone, Remdesivir and therapeutic Lovenox. Patient was diuresed as needed throughout hospital stay and pulmonary was consulted. Unfortunately the patient continued to have increased oxygen requirements and worsening respiratory distress requiring heated high-flow nasal cannula and was transferred to the ICU on 10/12/2021 and placed on AVAPS. Patient was started on a Precedex drip for agitation also started on broad-spectrum antibiotics as superimposed bacterial infection cannot be ruled out. Morning of 10/13/2021 code blue was called, CPR was started immediately and patient was intubated. Several rounds of ACLS were performed and patient was also given bicarb, calcium and dextrose. Unfortunately patient remained asystole or PEA and the code was eventually called. Time of death 0640 October 13th, 2021. Disposition: Deceased


VAERS ID: 1785118 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Alaska  
Vaccinated:2021-09-29
Onset:2021-10-13
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Morphine, Budesonide, Lorazepam, Trazadone, ASA, Spiriva, Ventolin, Ipratropium, Combivent,
Current Illness: Lung Cancer, CVA, Anxiety, COPD, GERD, Insomnia, Chronic Bronchitis,
Preexisting Conditions: Lung Cancer, CVA, Anxiety, COPD, GERD, Insomnia, Chronic Bronchitis,
Allergies: NKA
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Had Pfizer COVID on 12-18-20, 1-7-21. Have Pfizer COVID Booster on 9-29-21


VAERS ID: 1782334 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-13
Onset:2021-10-12
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Chest tube insertion, Computerised tomogram thorax normal, Culture, Death, Deep vein thrombosis, Dyspnoea, Endotracheal intubation, Faeces discoloured, Gastrointestinal haemorrhage, Haemofiltration, Hypotension, Intensive care, Mechanical ventilation, Oxygen saturation decreased, Pneumothorax, Renal impairment, Respiratory failure, SARS-CoV-2 test positive, Shock, Transfusion, Ultrasound Doppler abnormal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Gastrointestinal haemorrhage (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Ischaemic colitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Renal transplant x 3 on chronic immunosuppression, diabetes, hypertension, CAD
Allergies: Codeine, vancomycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/20 noticed increase SOB and went to urgent care on 9/23 for covid swab that was positive. Worsening SOB and EMS took her to Hospital. Stated she received a dose of steroids and antibiotics and discharged home. No improvement so family brought her to Medical Center on 9/24. CXR showed multifocal pneumonia secondary to covid. Transferred tp ICU from 9/28-10/4 due to increase oxygen requirements. Back to regular ward on 10.4-10/10. Being followed by transplant and nephrology and on enoxaparin for DVT. On 10/10 showed symptoms of GI bleed with hypotension, dark stools, anemia and worsening O2 requirements. Transferred back to ICU with O2 desaturation. Intubated for respiratory failure and on vent. Enoxaparin discontinued. Dopplers showed acute right peroneal vein thrombus. Transfused 3 units RBCs and q unit FFP. Cultures obtained and given cefepime, flagyl and zyvox. No further sings of bleeding. Renal function deteriorated rapidly and started on CRRT. CT revealed bilateral pneumothorax and chest tubes placed. Developed progressive shock requiring high doses of vasopressors. Family chose comfort care on 10/12 and patient passed away.


VAERS ID: 1782511 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-03-31
Onset:2021-10-12
   Days after vaccination:195
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, cardiac disease, CVA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient died 10/12/2021, not a covid related death


VAERS ID: 1782573 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-12
Onset:2021-10-12
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes Obesity
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: No adverse reaction from the vaccine. The pt. did get COVID 19 and expired from complications of COVID not the vaccine.


VAERS ID: 1782711 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-10-06
Onset:2021-10-12
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301458A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, COVID-19 pneumonia, Cardiac arrest, Central venous catheterisation, Computerised tomogram thorax abnormal, Cough, Dyspnoea, Endotracheal intubation, Exposure to SARS-CoV-2, Fibrin D dimer, Haematocrit decreased, Haemoglobin decreased, Headache, Hypoxia, Lung opacity, Nausea, Oxygen saturation decreased, Pain, Pyrexia, SARS-CoV-2 test positive, Tachypnoea, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-13
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Anemia, pelvic mass (non-malignant per report)
Allergies:
Diagnostic Lab Data: 10/12/21 - SARS-COV-2 PCR + 10/13/21 - CT scan: consistent with COVID pneumonia. 10/12/21 - H/H 4.0/16.2 10/12/21 - D-dimer; 8.23
CDC Split Type:

Write-up: Presented to ED with increased shortness of breath x 1 week and associated nausea/vomiting, cough, fevers, headaches, and body aches. Exposure to multiple COVID positive contacts. Was hypoxic on arrival to ER and tachypneic. Placed on HFNC but subsequently required intubation due to continued desaturations. Noted to have severe anemia and severe multi-lobar ground glass opacities consistent with pneumonia. Upon placement of central line, patient went into cardiac arrest and ROSC was unable to be achieved.


VAERS ID: 1785157 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-09
Onset:2021-10-12
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0151 / 3 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: treated for head and neck cancer with concurrent chemotherapy and radiation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was unexpectedly found deceased at home on 10/12/21


VAERS ID: 1785213 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-17
Onset:2021-10-12
   Days after vaccination:237
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 12 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Type 2 Diabetes, severe obesity, Hypertension
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt died after being diagnosed with COVID-19 on Sep 29, 2021


VAERS ID: 1785593 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-01-28
Onset:2021-10-12
   Days after vaccination:257
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Anaemia, COVID-19 pneumonia, Coagulopathy, Cyanosis, Embolism arterial, Encephalopathy, Endotracheal intubation, Epistaxis, Faeces discoloured, Heart rate decreased, Melaena, Mucosal haemorrhage, Pulmonary embolism, Rhabdomyolysis, Sepsis, Shock, Thrombocytopenia, Ultrasound scan abnormal, Upper airway obstruction
SMQs:, Rhabdomyolysis/myopathy (narrow), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, venous (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (narrow), Gastrointestinal haemorrhage (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: aortic valve replacement
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Admitted to hospital on 10/2 with covid pneumonia with acute hypoxia respiratory failure. Also stated history of having bright red bleeding per rectum. Treated with covid bundle medications. Intubated on 10/4 due to Upper airway obstruction due to large volume posterior aspect epistaxis. Internal maxillary artery embolization on 10/7 but continued to have anemia and thrombocytopenia with continued melanotic stool and suctioning of bleeding in the setting of severe sepsis. Received 9 units platelets and over 3 units PRBC. Diagnosed with bilateral sub segmental PEs but not candidate for anticoagulation due to bleeding risk. Evidence of rhabdomyolysis with AKI. Treated with cefepime and zyvox due to sepsis and shock. Coagulopathy continued with cyanosis of the upper and lower digits. Decreased pulsations in the dorsal pedis and upper extremities. Ultrasound showed no flow in right dorsalis pedis and dampened flow in right and left ulnar arteries. Given prophylactic anticoagulation due to bleeding risk. Mucosal bleeding increased. A=complicated course with encephalopathy and unable to be weend from vent. Family aware and transitioned to comfort care.


VAERS ID: 1776628 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-03
Onset:2021-10-10
   Days after vaccination:249
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT EXPIRED; COVID BREAKTHROUGH CASE


VAERS ID: 1778825 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-10-07
Onset:2021-10-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8839 / 3 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Pulse absent, Respiratory arrest, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received COVID booster shot (3rd dose) on 10/7/21. On 10/10/21 pt was found unresponsive/ no pulse/no resp. Hospice nurse pronounced death at 0820 on 10/10/21


VAERS ID: 1782307 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-06
Onset:2021-10-10
   Days after vaccination:246
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Asthenia, Bradycardia, Brain compression, Brain oedema, COVID-19, COVID-19 pneumonia, Cerebellar stroke, Cerebral mass effect, Computerised tomogram head abnormal, Computerised tomogram thorax abnormal, Death, Dyspnoea, Endotracheal intubation, Fibrin D dimer increased, Influenza A virus test, Influenza B virus test, Intensive care, Ischaemic stroke, Lateral medullary syndrome, Neurological examination abnormal, Oxygen saturation decreased, Positive airway pressure therapy, SARS-CoV-2 test positive, Ultrasound Doppler normal, Unresponsive to stimuli, Vertebral artery occlusion
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Nervous Stroke Compression Of Brain Hydrocephalus Respiratory Respiratory Failure Genitourinary Failure Renal Acute (Acute Kidney Injury) Infectious/Inflammatory COVID-19 Infection
Allergies: NKA
Diagnostic Lab Data: 10/11/2021 Influenza A/B, SARS CoV-2, PCR, Rapid, Varies- Sars CoV-2 PCR, Rapid DETECTED
CDC Split Type:

Write-up: transferred to hospital on 10/10/2021, Passed away on 10/12/2021 REASON FOR ADMISSION Stroke HOSPITAL COURSE Patient is a 79-year-old male admitted to the hospital on 10/10/2021 after he was found to have multiple focal ischemic strokes, mainly a left cerebellar stroke due to left vertebral artery and PICA occlusion. Past medical history if significant for atrial fibrillation on Xarelto, OSA on CPAP, and diabetes (on metformin). On 10/4/2021 he developed COVID-19 infection and presented to the ED for evaluation of shortness of breath and weakness. He was admitted to the medical floor and given supplemental oxygen, remdesivir, and dexamethasone. Around midnight on 10/10/2021 he became unresponsive and bradycardic with heart rates in the 30s with oxygen desaturation. He was initially placed on BiPAP but required intubation shortly thereafter. CT/CTA chest was obtained after intubation, negative for acute PE but did show findings consistent with Covid-19 pneumonia. Around 0200 a head CT was obtained which showed an acute left cerebellar infarct with effacement of the 4th ventricle and hydrocephalus with dilated 3rd ventricle and lateral ventricles. He was transferred to another hospital on 10/10/2021. Recommended starting barcitinib (JAK inhibitor) for COVID pneumonia. He was started on Lovenox 30 mg subcutaneous b.i.d. for D-dimer greater than 3000. Lower extremity ultrasound was negative for DVT. Neurology was consulted who recommended a repeat head CT with CTA 12 hours from the initial. CT/CTA at 1500 showed bilateral inferior cerebellar infarcts with an occluded left vertebral artery and left PICA. There is progressive edema with worse effacement of the 4th ventricle and the prepontine cistern. Given worsening mass effect and brain compression he was transferred to another hospital for management. His initial neurological exam was poor, although confounded by sedative medications. He was started on mannitol with improvement early in the day on 10/11/2021. Neurosurgery was consulted and evaluated. They discussed neurosurgical options with his family, who conveyed that surgical options would not reverse injury already sustained and therefore not be consistent with his wishes. His neurological exam worsened overnight on 10/11/2021 where he was not following commands in the left hemibody. Despite hydration and careful monitoring he developed acute kidney injury. Family including wife and three sons were updated via telephone regarding the severity of his strokes. After discussion they agreed that he would not want to live with neurological disability and losing any part of his independence would not be consistent with his wishes. He also had a living will stating that he would not want artifical means prolonging his life if recovery consistent with his wishes was not able to be achieved. Therefore, he was transitioned to comfort care measures after discussion with patients family on 10/12/2021. He passed away peacefully with family at the bedside at 4:44 pm.


VAERS ID: 1778769 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-21
Onset:2021-10-09
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019B21A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 2 UN / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes Hypertension Chronic Renal Disease COPD
Allergies: Unknown
Diagnostic Lab Data: PCR test administered by Hospital
CDC Split Type:

Write-up: Patient Contracted COVID-19 Patient Died from COVID-19 on 10/09/2021


VAERS ID: 1778854 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-05-04
Onset:2021-10-09
   Days after vaccination:158
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 1778866 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-09
Onset:2021-10-09
   Days after vaccination:214
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / IM

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE. VACCINE PROVIDED BY PHARMACY


VAERS ID: 1779140 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-11
Onset:2021-10-09
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 1779181 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-16
Onset:2021-10-09
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 - / SYR

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: COVID RELATED DEATH; BREAKTHROUGH CASE


VAERS ID: 1779241 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-02-12
Onset:2021-10-09
   Days after vaccination:239
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anal incontinence, Anxiety, Bedridden, Breath sounds abnormal, Breath sounds absent, Death, Diarrhoea, Dyspnoea, Grimacing, Moaning, Oedema peripheral, Pain, Painful respiration, Pallor, Perineal pain, Peripheral coldness, Pulse absent, Somnolence, Vaginal discharge, Vaginal fistula
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Pseudomembranous colitis (broad), Dyskinesia (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Initial visit. Patient is sitting up in bed drinking some juice. She is somewhat drowsy, drifting off to sleep when not directly engaged. PPS 30%; bedbound. Patient denies pain when asked; states she feels much better than last night. Son reports that she had a good deal of pain and anxiety last night, but it is much better this AM after she received some Roxanol and Ativan before bed. When she does have pain, it is in the perineum. Having copious amounts of thin, malodorous brown drainage/stool coming from the vaginal fistula. She often groans and grimaces when peri-care is performed. from Skin is intact and pale/cool to touch. Fingers and legs very cool to touch. Unable to obtain sats as fingers were cold to touch and unable to warm them up. Respirations unlabored at rest; labored if repositioned and with pain. LS diminished throughout. Edema 2+ BLE. BS active; having constant stool leaking. Discussed timeline, prognosis, and reviewed patient?s routine medications and CCK. Written instructions provided. Discussed POC with son. No refills needed. Instructed to call hospice with any changes or concerns. Visit made to pronounce death. Patient had no pulse or respirations at time of visit


VAERS ID: 1782634 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-03-29
Onset:2021-10-09
   Days after vaccination:194
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: hypertension, cardiac disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine #1 Moderna 3/1/2021 Lot # 011A21A patient died from cardiac arrest on 10/9/2021, not a covid related death


VAERS ID: 1785145 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Alabama  
Vaccinated:2021-09-28
Onset:2021-10-09
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020F21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Acute respiratory failure, Angiogram, COVID-19 pneumonia, Chest X-ray, Death, Dyspnoea, Echocardiogram, Endotracheal intubation, Hypoxia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Trelegy Ellipta 100/62.5 mg , Spironolactone 25 mg, sildenafil 20 mg, prevacid 15 mg, prednisone 20 mg, lasix 20 mg, Lexapro 20 mg, Eliquis 5 mg, Daliresp 500 mcg, cetirizine 10 mg, albuterol HFA
Current Illness: Pulmonary Hypertension, GERD, Pulmonary edema, diastolic heart failure, left ventricular hypertrophy, asthma, raynaulds syndrome, congestive heart failure
Preexisting Conditions: Pulmonary Hypertension, GERD, Pulmonary edema, diastolic heart failure, left ventricular hypertrophy, asthma, raynaulds syndrome, congestive heart failure
Allergies: tomato
Diagnostic Lab Data: cta scan, covid test, echocardiogram, cxr
CDC Split Type:

Write-up: Death diagnosed with covid pneumonia, hypoxia, acute respiratory failure, intubation, Death increased sob reported on 10/8/2021, recommended to go to ER. Patient admitted to Hospital. Death on 10/10/2021


VAERS ID: 1785320 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-10
Onset:2021-10-09
   Days after vaccination:182
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute left ventricular failure, Acute respiratory failure, Bradycardia, COVID-19, Cardio-respiratory arrest, Catheterisation cardiac, Chronic left ventricular failure, Death, Dyspnoea, Endotracheal intubation, Hypotension, SARS-CoV-2 test positive, Ventricular assist device insertion
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: HTN, AORTIC STENOSIS
Allergies: NO KNOWN MEDICATION ALLERGIES
Diagnostic Lab Data: 10/9/2021 COVID-19SARSCoV2 = DETECTED
CDC Split Type:

Write-up: 10/8/21 PATIENT ADMITTED TO MEDICAL CENTER aCUTE ON CHRONIC lv SYSTOLIC HEART FAILURE. PATIENT REPORTING SOB , CARDIAC CATH SHOWED NORMAL, ACUTE RENAL FAILURE NOTED .imPELLA DEVICE PLACED. COVID + ACUTE RESP FAILURE. 10/9/21 PATIENT HAD CARDIOPULMONARY ARREST. PATIENT INTUBATED . PATINET PROGRESSIVELY MORE HYPOTENSION AND BRADYCARDIC. ON 10/9/21 PATIETN DIED.


VAERS ID: 1775807 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-10-07
Onset:2021-10-08
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ763AC / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: on 10/08/2021 we received a call from a nurse that the patient was found dead in her bed. she was not having any ailment prior to that.


VAERS ID: 1776569 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-05-12
Onset:2021-10-08
   Days after vaccination:149
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: fully vaccinated-covid 19 death


VAERS ID: 1776673 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-10-01
Onset:2021-10-08
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Pulmonary embolism, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cymbalta Relafen
Current Illness: Dementia and urinary incontinence
Preexisting Conditions: Dementia
Allergies: knda
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was alert, ambulating in hallway. Patient a sudden, unexpected death in her sleep. Most likely suspect pulmonary embolis. However, patient has no pre-exisiting condition to explain this sudden death


VAERS ID: 1777314 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Montana  
Vaccinated:2021-10-08
Onset:2021-10-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FE3590 / 3 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, No reaction on previous exposure to drug
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Novolog, pradaxa, pantoprazole, bumetanide, clopidogrel, sildenafil, calcitriol, brilinta, amlodepine, atorvastatin, potassium chloride, spironolactone, metoprolol, lantus
Current Illness: hypotension
Preexisting Conditions: COPD, Congestive heart failure, Diabetes
Allergies: Xarelto, Eliquis
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient did well with the first two doses, received the booster and two hours after he passed away. According to the wife, he was alright in the two hour time frame post vaccination. He went shopping and showed no signs of anaphylaxis or intolerance.


VAERS ID: 1779214 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-10
Onset:2021-10-08
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939906 / 3 RA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UJ694AA / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: loratadine, fluticasone, omeprazole, lisinopril, tizanidine, carvedilol, hydrocortisone tablet, amlodipine, advair, magnesium oxide, potassium chloride liquid, imodium, prochlorperazine, gabapentin, ferrous sulfate, nortriptyline
Current Illness: anemia, ileostomy, type 2 Diabetes mellitus, Wolff-Parkinson-White, chronic pancreatitis, nicotine dependence, adrenal insufficiency, GERD, Crohns, hypertension, mild intermittent asthma, sleep apnea, hypokalemia
Preexisting Conditions: anemia, ileostomy, type 2 Diabetes mellitus, Wolff-Parkinson-White, chronic pancreatitis, nicotine dependence, adrenal insufficiency, GERD, Crohns, hypertension, mild intermittent asthma, sleep apnea, hypokalemia
Allergies: cephalexin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Notified by medical examiner that patient was found deceased at home 10/08/2021, no report of symptoms in interim


VAERS ID: 1774925 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-15
Onset:2021-10-07
   Days after vaccination:206
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9267 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardio-respiratory arrest, Death, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted and being treated for covid. She was receiving maximal therapy (see my progress note from today), but unfortunately underwent a cardiopulmonary arrest. Patient started to be resuscitated, but discussions with family revealed that she did not want to be put on a machine. She was made a DNR and comfort medications (morphine) were administered given pain of CPR. Patient passed shortly after stopping CPR.


VAERS ID: 1778922 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-16
Onset:2021-10-07
   Days after vaccination:174
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acidosis, Arterial catheterisation, Auscultation, Breath sounds abnormal, COVID-19, Cardio-respiratory arrest, Central venous catheterisation, Computerised tomogram thorax abnormal, Condition aggravated, Death, Dyspnoea, Endotracheal intubation, General physical health deterioration, Hyperkalaemia, Hypoxia, Intensive care, Intestinal ischaemia, Lung infiltration, Lung opacity, Multiple organ dysfunction syndrome, Oxygen saturation decreased, Pallor, Pneumonia, Pulmonary embolism, Rales, Renal failure, Respiratory fatigue, SARS-CoV-2 test positive, Septic shock, Tachycardia, Tachypnoea, Wheezing, pH body fluid
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir, amylase-lipase-protease, Biotin 2500, buPROPion, ca, Caffeine calCITriol copper gluconate Cyanocobalamin cyclobenzaprine ferrous sulfate furosemide HYDROcodone-acetaminophen latanoprost multivitamin olanzapine omeprazole
Current Illness: N/A
Preexisting Conditions: COPD, ARF, esophageal obstruction, major depressive disorder, coagulopathy, Drug-induced hypokalemia, pulmonary emboli
Allergies: N/A
Diagnostic Lab Data: SARS-COV-2 (COVID-19) by NAA, Micro (See Responses to 18)
CDC Split Type:

Write-up: 9/24 PMHx of COPD, pneumonia, pulm HTN, Anxiety who presents for SOB w/ wheezing x 3 days. Diag. w/ Pneumonia upon assessment. 9/25 CT suspicious for small pulmonary emboli. Examination of the lungs reveals numerous groundglass airspace opacities throughout the upper lobes and lower lobes bilaterally. 9/28 Lungs reduced to auscultation bilaterally. Right lower lobe crackles. On CT There is interval worsening in aeration with development of bilateral infiltrates diffusely throughout both lungs. The pleural spaces remain clear. 10/4 patient currently requiring warmed high flow oxygen at 45L. Overnihgt desaturations into 10/5 10/6 pt desat to 62%, pt pale, tachypenic, tachycardic. Rapid response called to aid 10/6 Again RRT was called due to hypoxia Osat was in mid 80s%, pt was on high flow 10/6 She has been transferred to the ICU due to worsening respiratory status. Discussed plan for EGD tomorrow with patient and her daughter at the bedside. 10/6 Called to ICU patient showing signs of respiratory fatigue, requested to intubate patient. Patient oxygenated with ambu bag and mask with FiO2 100%. Intubation followed. 10/7 Central Line Placement - Right Internal Jugular 10/7 COIVD+ Result 10/7 Discussed with family poor prognosis, and clinical deterioration, will remain full code 10/8 CRITICAL CARE PROCEDURE NOTE - ARTERIAL CATHETER INSERTION 10/8 Septic shock with multiple organ failure, suspect ischemic bowel 10/8 Code blue called at 05:31 pm. On arrival to room, patient had achieved ROSC. Per nursing staff patient has been severely acidotic throughout the day with pH<7. Patient is on multiple pressors. Renal failure with hyperkalemia. There was suspicion for possible ischemic bowel however CT of abdomen could not be obtained as patient is too unstable. Patient had coded again while I was at rapid response. Per nurse staff ED doctor present for the code and pronounced patient


VAERS ID: 1779515 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-03
Onset:2021-10-07
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030A21A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19 pneumonia, Death, Diabetes mellitus inadequate control, Respiratory failure, Sepsis
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated against Covid-19, died on 10/07/2021 from complications of Covid-19 pneumonia respiratory failure, sepsis, and uncontrolled diabetes. Second Moderna dose administered on 03/31/2021. Second Moderna dose Lot # 025B21A. Patient


VAERS ID: 1782614 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-02-17
Onset:2021-10-07
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 2 - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Condition aggravated, Death, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: diabetes, hypertension, TIA, OSA, dementia, glaucoma, pneumonia
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 1/30/2021 Moderna lot # 029K20A patient dies of pneumonia, not a covid related death


VAERS ID: 1784391 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-10-05
Onset:2021-10-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF3620 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20211005; Test Name: Body temperature; Result Unstructured Data: Test Result:36.3 Centigrade; Comments: before vaccination
CDC Split Type: JPPFIZER INC202101335016

Write-up: Sudden death; This is a spontaneous report from a contactable physician (vaccinator) via the Regulatory Authority; report number is v21129007. A 56-year and 1-month-old male patient received BNT162b2 (COMIRNATY, Solution for injection), via an unspecified route of administration on 05Oct2021 18:00 (lot number: FF3620; Expiration Date: 30Nov2021) as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. Historical vaccine included first dose of BNT162B2 on 14Sep2021 (Lot# FF3620, Expiration date 30Nov2021) for COVID-19 immunization. The patient experienced sudden death on 07Oct2021 (2 days after the vaccination). The clinical course was as follows: Body temperature before vaccination was 36.3 degrees centigrade. On 07Oct2021, the police contacted the reporting physician''s hospital and reported that the patient was found dead at her home. Therefore, the reporting physician reported on the medical treatment progress. It was unknown about history of the patient''s death. The reporting physician classified the event as serious (death) and assessed the causality between the event and BNT162b2 as un-assessable. The patient died on 07Oct2021. It was not reported if an autopsy was performed. The reporting physician commented as follows: The patient died 2 days after the vaccination, so it was difficult to consider anaphylaxis as the cause. It was presumed that sudden death was due to thrombosis or completely different factor.; Reported Cause(s) of Death: Sudden death


VAERS ID: 1768253 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-05
Onset:2021-10-06
   Days after vaccination:215
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Brain compression, COVID-19, Cerebellar stroke, Hydrocephalus, Intensive care, Medical device removal, Neurological symptom, Oedema, SARS-CoV-2 test positive, Therapy cessation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, hypertension, esophageal cancer s/p resection and ventriculostomy placement
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Had tested covid + on 8/-22-25 at another facility. Admitted on 9/14 with large right cerebellar stroke, edema, compression and hydrocephalus. Has required multiple admissions to ICU for neuro status changes. Covid + on admission by PCR. Family requested no aggressive treatment. Ventriculostomy stopped draining and removed. Family requested comfort care only.


VAERS ID: 1776894 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-10-04
Onset:2021-10-06
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 3 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Warfarin, Alprazolam, losartan-hydrochlorothiazide, sertraline, atorvastatin, metoprolol,
Current Illness: none
Preexisting Conditions: hypercholesterolemia, dyspnea, prostate cancer, hypertension, migraine, diabetes type 2, coronary artery disease, anxiety, transient global amnesia, tobacco use
Allergies: Levaquin, Statins
Diagnostic Lab Data: none
CDC Split Type:

Write-up: I received a call from patient''s daughter who was upset he received the COVID booster on Monday October 4, 2021 and died of a MI on October 6, 2021. I am not sure where he received the booster or where he received it.


VAERS ID: 1779236 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-06-22
Onset:2021-10-06
   Days after vaccination:106
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, COVID-19, Death, Respiratory failure
SMQs:, Anaphylactic reaction (broad), Interstitial lung disease (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was fully-vaccinated and admitted to the hospital with COVID. Patient had multiple comorbidities and passed away while in the hospital secondary to severe respiratory failure and ARDS.


VAERS ID: 1782901 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-27
Onset:2021-10-06
   Days after vaccination:193
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: COVID-19, Cough, Pneumonia, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, dementia, TIA, breast cancer
Allergies:
Diagnostic Lab Data: COVID positive 10/7/21
CDC Split Type:

Write-up: Cough, pneumonia, COVID


VAERS ID: 1783275 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-06
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: COVID-19, Vaccination failure
SMQs:, Lack of efficacy/effect (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEJNJFOC20211022687

Write-up: Vaccination failure; COVID-19; This spontaneous report received from a consumer via a Regulatory Authority (EVHUMAN Vaccines, DE-PEI-202100204687) on 12-OCT-2021 and concerned a 79 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin, and batch number were not reported) 1 dosage forms, 1 total administered on 30-AUG-2021 for an unspecified indication. The batch number was not reported. Per procedure, no follow-up will be requested for this case. No concomitant medications were reported. On 06-OCT-2021, the patient experienced vaccination failure, and was hospitalized (date unspecified). On 06-OCT-2021, the patient experienced covid-19. On an unspecified date, the patient died from vaccination failure, and covid-19. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death, and Hospitalization Caused / Prolonged).; Sender''s Comments: G.S.SARS-CoV-2-positivetive PCR Test am 06 10 2021.; Reported Cause(s) of Death: VACCINATION FAILURE; COVID-19


VAERS ID: 1761528 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-10
Onset:2021-10-05
   Days after vaccination:209
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Anticoagulant therapy, Atrial fibrillation, COVID-19 pneumonia, Cardiac failure, Chest tube insertion, Condition aggravated, Death, Endotracheal intubation, General physical health deterioration, Hypoxia, Intensive care, Multiple organ dysfunction syndrome, Pneumothorax, Renal failure, Respiratory failure
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension, anxiety, vitamin D deficiency, obesity class 3, obstructive apnea, allergic rhinitis, chronic kidney disease, atrial fibriliation.
Allergies: Hydrocodone (itching), Robitussin (chest tightness), soaps, animal dander, cosmetics.
Diagnostic Lab Data: COVID positive test on 09/20/21.
CDC Split Type:

Write-up: Fully vaccinated patient admitted for COVID pneumonia. Provider discharge note: "Admitted to the hospital on September 20, 2021 for hypoxia. She was fully vaccinated against COVID-19. At that time she is requiring high-flow nasal cannula oxygenation. On 09/20 for a CT scan was done which showed a possible nonocclusive emboli in the left lower lung. She was started on heparin. She was transferred to the intensive care unit on the morning of 09/30/2021. She developed bilateral pneumothoracies that time. She was intubated and chest tubes were placed. Over the next 5 days she developed worsening ARDS with multiorgan system failure. This presented initially with AFib with RVR and progressed to kidney failure. On the morning of 10/04/2021 the patient''s family decided that they did not want to pursue additional care. Her respiratory cardiac function decreased until 9:45AM on 10/5/2021 when she passed away."


VAERS ID: 1766155 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-09-27
Onset:2021-10-05
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301308A / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Found dead in her bathroom floor 8 days after vaccine. Was fine the night before.


VAERS ID: 1768151 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-09-03
Onset:2021-10-05
   Days after vaccination:32
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 3 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cardiac arrest, Chest pain, Dyspnoea, Electrocardiogram abnormal, Resuscitation, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: end-stage renal disease, Hypertension, CAD with pacemaker
Allergies: Codeine, Penecillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diagnosed with COVID on 9/22 and treated OP with antibiotics and monoclonal antibody infusion. Admitted to hospital on 10/5 with increasing chest pain and shortness of breath. Abnormal EKG. Cardiology and Nephrology followed patient. COVID + on admission. Had cardiac arrest with 5 rounds of chest compressions and multiple meds. Family contacted and requested DNR so ACLS was terminated.


VAERS ID: 1768207 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-19
Onset:2021-10-05
   Days after vaccination:200
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, COVID-19 pneumonia, Cardioversion, Ejection fraction decreased, Electrocardiogram ST segment elevation, Endotracheal intubation, Haemofiltration, Hepatic failure, Hypoxia, Mechanical ventilation, Oxygen saturation decreased, Pneumothorax, Pulse absent, Respiratory failure, Resuscitation, Seizure like phenomena, Shock, Ventricular tachycardia, Vomiting
SMQs:, Torsade de pointes/QT prolongation (narrow), Acute renal failure (narrow), Cardiac failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Myocardial infarction (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Convulsions (narrow), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, hypertension, leukemia
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Transfer from clinic where patient was attempting to receive monoclonal antibody infusion when found to be hypoxic with SPO2 in low 80s. Upon arrival to our hospital vomited and underwent seizure like activity and lost pulse. CPR initiated with v tach. Defibrillated, intubated, started on amiodarone drip. Developed shock and started on levophed and propofol drips. STAT EKG showed ST elevation, code STEMI was called. Ejection fraction 15%. Started on remdesevir for covid pneumonia but stopped due to liver failure. Given dexamethasone. Developed right sided pneumothorax and developed renal failure requiring CRRT. Increasing respiratory failure with max vent settings and flolan. Family decided to transition to comfort care.


VAERS ID: 1768495 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-08-25
Onset:2021-10-05
   Days after vaccination:41
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3248 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Haemorrhage intracranial
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death - Acute intracranial hemorrhage


VAERS ID: 1769028 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-09-25
Onset:2021-10-05
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30145BA / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client had 1 dose of covid 19 vaccine, client died-due to complications of covid-19


VAERS ID: 1782423 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-07
Onset:2021-10-05
   Days after vaccination:181
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 1 RA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030B21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, Chest pain, Cough, Death, Diarrhoea, Dyspnoea, Fatigue, Headache, Oropharyngeal pain, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-11
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, cardiovascular disease, and anxiety
Allergies:
Diagnostic Lab Data: Coronavirus RNA PCR specimen collected 9/30/2021
CDC Split Type:

Write-up: Hospitalized and death; symptoms include fever, rhinorrhea, sore throat, cough, shortness of breath, chest pain, headache, fatigue, diarrhea, congestion, and loss of taste/smell.


VAERS ID: 1782712 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-02-15
Onset:2021-10-05
   Days after vaccination:232
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Back pain, COVID-19, Death, Dyspnoea, Dyspnoea exertional, Dysstasia, Fall, Head injury, Hypoxia, Positive airway pressure therapy, Rib fracture, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Osteoporosis/osteopenia (broad), Arthritis (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID rapid test (10/5/2021) = positive
CDC Split Type:

Write-up: Patient is a 76 y.o. female patient injured as a result of a fall from standing height on 10/3/2021. Patient reports she slipped on water in her bathroom and hit her head, but denies LOC. Patient denies any difficulty breathing or chest pain at the time. She actually denies any pain from her fall. She was not able to get herself up from the bathroom floor and slept there that night. The following day she crawled into her bed room and was able to call for help. She again denies any pain or difficulty breathing, just general weakness preventing her from being able to get up from the floor. On the day of presentation she had developed pain of her back and right hip and this was her reason for presentation. She also reports that she had shortness of breath for the past 2 weeks especially on exertion. On evaluation in the ED she has been found to be COVID (+) and multiple rib fractures in various stages of healing. She was started on oxygen via nasal cannula on 10/5/2021. She was also started on dexamethasone at that time. She became more hypoxic and oxygen requirements increased, and she was requiring Bipap on 10/8/2021. She was started on remdesivir on 10/8/2021. Patient refused intubation and was made comfort measures on 10/9/2021. The patient expired on 10/10/2021.


VAERS ID: 1784377 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-10-05
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPPFIZER INC202101326005

Write-up: Acute myocardial infarction; This is a spontaneous report from a contactable physician received from the Regulatory Agency. Regulatory authority report number is v21128805. A 67-year-old male patient received the second dose of bnt162b2 (COVID-19 VACCINE - MANUFACTURER UNKNOWN), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as DOSE 2, SINGLE for covid-19 immunisation. The patient medical history was not reported. The patient''s concomitant medications were not reported. The patient previously took the first dose of bnt162b2 (COVID-19 VACCINE - MANUFACTURER UNKNOWN) on an unknown date for covid-19 immunisation. The patient experienced acute myocardial infarction on 05Oct2021 17:30 with outcome of fatal. Therapeutic measures were taken as a result of acute myocardial infarction. The patient died on 05Oct2021. It was not reported if an autopsy was performed. The course of the event was as follows: On 05Oct2021 around 17:30 (after an unknown time gap from the vaccination), the patient was found lying down in front of the pachinko parlor. At contact with the emergency squad, the patient was in cardiac arrest. After arrival at the hospital, percutaneous cardiopulmonary support (PCPS) was introduced. The cause of cardiac arrest was acute myocardial infarction. The reporting physician classified the event as serious (fatal) and assessed the causality between the event and BNT162b2 as unassessable. It was not reported whether there were other possible causes of the event such as any other diseases. The reporting physician commented as follows: There was little relation.; Reported Cause(s) of Death: Acute myocardial infarction


VAERS ID: 1760669 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Pain in extremity, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: none reported
Allergies: none
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Per niece a couple hours after getting the vaccine started to have issues with arm and his wife took him to the hospital to get checked out. It was took late by the time getting to the hospital and patient passed away around 1 pm. Per the coroner the preliminary cause of death is a blood clot. This information was provided to the pharmacy by the patients niece around 3 pm.


VAERS ID: 1761864 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-10-01
Onset:2021-10-04
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / UNK - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death, Hyperhidrosis, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL, XANAX, AMIODORONE, ELIQUIS, LASIX, HYDROCHLORIQUINE, SYNTHROID, MELATONIN, MIDODRINE, PRILOSEC, PLAQUENAL, PREDNISONE, SENNA PLUS, SPIRONOLACTONE, VIT D, prn: DULCOLAX SUPPOSITORY, MIRALAX, MILK OF MAGNESIA, ZOFRAN, ULTRAM
Current Illness: ADMITTED TO FACILITY 9/29/21 AFTER FALLS AT HOME. RECEIVED J&J VACCINE FROM PHARMACY ON 10/1/21. ON 10/4, STAFF PRESENT IN ROOM, RESIDENT BECAME DIAPHORETIC, PALE, AND UNRESPONSIVE. SHE EXPIRED MOMENTS LATER.
Preexisting Conditions: PMH: LUPUS, HYPOTHYROIDISM, OSTEOPOROSIS, ANXIETY, PAC, HTN, CHF, BRONCHITIS, CKD, PNA, INFLUENZA A, MITRAL VALVE REG. MITRAL STENOSIS, CERVICAL FX 2019
Allergies: AMLODIPINE, CELEBREX
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: ADMITTED TO FACILITY 9/29/21 AFTER FALLS AT HOME. RECEIVED J&J VACCINE FROM PHARMACY ON 10/1/21. ON 10/4, STAFF PRESENT IN ROOM, RESIDENT BECAME DIAPHORETIC, PALE, AND UNRESPONSIVE. 911 CALLED, RESIDENT EXPIRED MOMENTS LATER.


VAERS ID: 1761916 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-09-29
Onset:2021-10-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF8841 / 3 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Body temperature increased, Chest X-ray abnormal, Lung infiltration
SMQs:, Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multiple medications, recently started on IM Rocephin for dx of Pnuemonia on 10/1/2021.
Current Illness: Dementia, HTN, Malignant neoplasm of colon, hx of COVID-19, CKD, Atherosclerotic heart disease, Hx of MRSA pneumonia, GI Bleed. Plus many more diagnoses.
Preexisting Conditions: Recieved Booster Pfizer Vaccine on 9/29/21, on 9/30/21 had temp of 106.0, then 103.0, 102.0. CXR showed bilat infiltrates, started on rocephin., temp down to 97.9 on 10/1/21. Multiple long standing chronic health conditions, active with Hospice Services. DNR/DNI. On Aspiration Precautions.
Allergies: Gabapentin, diclofenac, ibuprofen, morphine, ranitidine
Diagnostic Lab Data: CXR DONE 10/1/21 SHOWED BILATERAL INFILTRATES
CDC Split Type:

Write-up: Recieved Booster Pfizer Vaccine on 9/29/21, on 9/30/21 had temp of 106.0, then 103.0, 102.0. CXR showed bilat infiltrates, started on rocephin., temp down to 97.9 on 10/1/21. Multiple long standing chronic health conditions, active with Hospice Services. DNR/DNI. On Aspiration Precautions.


VAERS ID: 1762703 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 019F21A / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UT7319KA / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cardiac arrest, Death
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None discussed or known.
Preexisting Conditions: Pt discussed having heart issues and diabetes during administration, as we discussed possibly considering other vaccines such as pneumonia and shingles vaccines in the future. Nothing documented. Pt did not fill maintenance medications at our pharmacy. Was a new patient to us at time of vaccination.
Allergies: None
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt received vaccines at our pharmacy the morning of 10/4/21. She was monitored for 15 minutes after vaccination and no reactions were noted or observed in the patient waiting time. She left without any known complications. On 10/5/21, the Coroner came to the pharmacy with documents to retrieve medical records for the patient as she had "went into cardiac arrest yesterday and needed these records for the autopsy investigation." After contacting my direct supervisor and he contacted necessary persons to confirm the release of the PHI, we called him back to inform him he could come to pick up records. There was no communication in between the time the patient left the pharmacy without complications from the vaccines and the time the coroner came to pharmacy to retrieve patient records for her death.


VAERS ID: 1771603 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2021-09-30
Onset:2021-10-04
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048F21A / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Acute hepatic failure, Death
SMQs:, Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Levemir subcutaneous insulin daily
Current Illness: Type 1 Diabetes mellitus, endometriosis, hypothyroidism
Preexisting Conditions: Type 1 Diabetes mellitus, endometriosis, hypothyroidism
Allergies: Clindamycin, Penicillin
Diagnostic Lab Data: In hospital medical record
CDC Split Type:

Write-up: Hospitalization, acute liver failure & death on 10/8/2021


VAERS ID: 1774923 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-11
Onset:2021-10-04
   Days after vaccination:235
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Angiogram pulmonary normal, Anticoagulant therapy, COVID-19 pneumonia, Death, Dialysis, Electrolyte imbalance, General physical health deterioration, Livedo reticularis, Peripheral coldness, Peripheral ischaemia, Platelet count decreased, Pneumonia bacterial, Renal failure, Thrombocytopenia, Thrombosis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted due to acute hypoxic respiratory failure secondary to COVID-19 pneumonia. Additionally was found to have bacterial pneumonia started on cefepime and Zithromax. He was started on remsedivir along with Decadron. CTA was negative for pulmonary embolism. A few days into hospitalization the patient developed acute kidney injury nephrology was consulted felt it was likely secondary to thrombus. The patient also developed bilateral foot ischemia surgery is consulted and recommended continuation of anticoagulation. Surgery is consulted for line placement as the patient''s renal failure progressed to needing dialysis with electrolyte abnormality and the patient''s warfarin was reversed. The following day the patient developed severe thrombocytopenia with platelet count and in the 30s thus further anticoagulation was held and hematology was consulted. The patient''s lower extremity ischemia progressed and his extremities were cold mottled from the knee down. Multiple conversations were had with the patient and family and yesterday they decided given his overall poor prognosis and worsening condition the patient his family decided to cease aggressive care efforts and requested comfort measures. The patient passed away today with family at bedside.


VAERS ID: 1776391 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-04-30
Onset:2021-10-04
   Days after vaccination:157
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017B21A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Malaise, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: CONGESTIVE HEART FAILURE, T2DM, HTN, MULTIPLE MYELOMA UNDERGOING CHEMOTHERAPY.
Allergies:
Diagnostic Lab Data: POSITIVE COVID TEST 10/4/21
CDC Split Type:

Write-up: DEVELOPED SYMPTOMS AND TESTING POSITVE FOR COVID19 10/4/21


VAERS ID: 1780142 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-04-22
Onset:2021-10-04
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal distension, Anaemia postoperative, Blood loss anaemia, COVID-19, Chest X-ray normal, Computerised tomogram normal, Death, Gastrointestinal disorder, Hypotension, Lactic acidosis, Packed red blood cell transfusion, Respiratory failure, SARS-CoV-2 test positive, Stoma site haemorrhage, Transfusion, Vasopressive therapy
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Lactic acidosis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Myelodysplastic syndrome (broad), Respiratory failure (narrow), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-09
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen PRN, atorvastatin, citalopram, Lomotil PRN, loperamide, midodrine, omeprazole, ondansetron PRN, TPN, zolpidem PRN
Current Illness:
Preexisting Conditions: history of endometrial CA, s/p hysterectomy, XRT, requiring bowel resection and diverting ostomy, short gut syndrome, chronic nausea on TPN, bladder CA s/p incomplete resection, solitary kidney with CKD3, chronic ureteral obstruction s/p nephrostomy tube placement
Allergies: Erythromycin, Penicillins
Diagnostic Lab Data: COVID status positive 10/4/21 and 10/6/21
CDC Split Type:

Write-up: Patient received Pfizer COVID vaccine on 3/17/21 and 4/22/21 at another facility. On 9/27/21, patient admitted to our facility for acute blood loss anemia from ostomy. COVID status was negative on 9/27/21 and 9/29/21. However, COVID status changed to positive on 10/4/21 and 10/6/21. Patient expired on 10/9/21 likely related to abdominal pathology. Here''s the discharge summary from hospitalist: "Patient with recurrent bleeding episodes from her stoma requiring total of 8 U PRBC. CT for GIB was negative for active bleeding on admission. She was seen by GI service who felt there is no role for GI controlling bleed. Colorectal surgery was contacted after an other episode of large quantity bleed. Unfortunately she developed progressive hypoxic respiratory failure with abdominal distention, lactic acidosis, progressive hypotension requiring HFNC, vasopressor support, transfusion. CXR was surprisingly clear and felt that severe hypoxia likely related to abdominal pathology."


VAERS ID: 1785234 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Oklahoma  
Vaccinated:2021-08-31
Onset:2021-10-04
   Days after vaccination:34
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / 2 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Brain death, COVID-19, Cerebral haemorrhage, Computerised tomogram head abnormal, Diarrhoea, Endotracheal intubation, Hypertensive emergency, Laboratory test, Magnetic resonance imaging head abnormal, Mental status changes, Movement disorder, Respiratory failure, SARS-CoV-2 test positive, Thalamus haemorrhage, Treponema test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Pseudomembranous colitis (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine, clonidine patches, albuterol HFA
Current Illness: NA
Preexisting Conditions: High Blood pressure
Allergies: NKA
Diagnostic Lab Data: 10/05/2021: tested negative for COVID twice per NP swab 10/06/2021: tested positive for COVID via tracheal aspirate
CDC Split Type:

Write-up: 08/31/2021: Second dose of COVID19 vaccine received. 10/04/2021: EMS respond to 911 call. Patient was found in car with altered mental status, unable to move left side, experiencing vomiting and diarrhea. 10/05/2021: Brought to ER by EMS as a code stroke. Pt admitted after acute IP hemorrhage (confirmed on ED CT and MRI) involving R thalamus with accompanied hypertensive emergency, AKI, and respiratory failure. No surgical treatment indicated for hemorrhage. Patient intubated, nursing staff suctioning and laid on side as vomiting persisted. Given anti hypertensives and vasopressor. 10/06/2021: Patient pronounced brain dead at 0752. 10/06/2021: consulted and performed routine lab work for organ donation. Patient found to be syphillis positive and COVID positive by tracheal aspirate.


VAERS ID: 1786357 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-03-16
Onset:2021-10-04
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6207 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, Adenovirus test, Agitation, Angiogram pulmonary abnormal, Arrhythmia, Asthenia, Atelectasis, Blood test, Body temperature increased, Bordetella test negative, Bradycardia, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Cardiac failure congestive, Chest X-ray abnormal, Chlamydia test negative, Chronic kidney disease, Chronic left ventricular failure, Computerised tomogram thorax abnormal, Condition aggravated, Confusional state, Cough, Death, Decreased appetite, Diarrhoea, Dyspnoea, Dyspnoea exertional, Electrocardiogram abnormal, Emphysema, Enterovirus test negative, Fatigue, Heart rate decreased, Human metapneumovirus test, Human rhinovirus test, Hypoxia, Influenza A virus test negative, Influenza B virus test, Infusion, Insomnia, Interstitial lung disease, Lung infiltration, Lung opacity, Metabolic encephalopathy, Mycoplasma test negative, Pleural effusion, Productive cough, Pulmonary fibrosis, Pulmonary oedema, Pyrexia, Respiratory distress, Respiratory syncytial virus test, Respiratory viral panel, SARS-CoV-2 test positive, Scan with contrast abnormal, Sepsis, Supraventricular extrasystoles, Suspected COVID-19, Wheelchair user
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Chronic kidney disease (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-10
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness:
Preexisting Conditions: Respiratory Allergic rhinitis Chronic obstructive pulmonary disease Hypoxia Postinflammatory pulmonary fibrosis Shortness of breath Acute on chronic respiratory failure with hypoxia Circulatory Benign essential hypertension Mitral regurgitation Pulmonary hypertension Digestive Tubular adenoma of colon Vitamin D deficiency Diverticulosis of large intestine without hemorrhage Genitourinary Benign prostatic hyperplasia (BPH) with straining on urination Chronic kidney disease, stage 3 Musculoskeletal Arthritis of shoulder region, degenerative Squamous cell carcinoma of upper extremity Basal cell carcinoma of skin Atypical fibroxanthoma of skin Actinic keratosis Squamous cell cancer of skin of right forearm Endocrine/Metabolic Hypercholesterolemia Hypocalcemia Acquired hypothyroidism Prediabetes Hematologic Anemia Immune Severe sepsis Other Anxiety Edema Right inguinal hernia Squamous cell carcinoma
Allergies: Advair Diskus [Fluticasone Propion-salmeterol]Palpitations EscitalopramConfusion / Delirium SimvastatinMyalgia / Muscle Pain FenofibrateOther (document details in comments) PravastatinOther (document details in comments)
Diagnostic Lab Data: 10/05/2021 1528 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 10/05/21 1528 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result Detected Critical Results Procedure Component Value Ref Range Date/Time CT angiogram chest pulmonary embolism with and without contrast [3307542570] Resulted: 10/08/21 1304 Order Status: Completed Updated: 10/08/21 1305 Narrative: CTA CHEST PULMONARY EMBOLISM W WO CONTRAST IMPRESSION: Underlying pattern of panlobular emphysema and chronic interstitial inflammatory change with overall marked increase of opacities from the CT of 9/22/2012. Cannot differentiate between progressive interstitial disease versus superimposed infiltrate or edema. Minimal left effusion. No definite pulmonary embolus. See above. RV/LV Ratio: N/A END OF IMPRESSION: INDICATION: Shortness of breath and sepsis and history of Covid positivity Assess for pulmonary artery embolism. TECHNIQUE: Enhanced helical CT scan of the chest was performed from the lung apices to below the diaphragm. 2 mm axial reconstruction with MPR coronal, oblique and sagittal images were created. 3D shaded surface images also created on a separate workstation and permanently stored. CONTRAST: 80mL of IODIXANOL 320 MG IODINE/ML INTRAVENOUS SOLUTION administered INTRAVENOUS. Quality of contrast opacification was adequate. COMPARISON: 9/22/2012 FINDINGS: There is a background pattern of severe interstitial disease which has progressed since 9/22/2012. Panlobular emphysema. Minimal left effusion. There certainly may be a superimposed diffuse inflammatory changes but I cannot differentiate from interval chronic changes worsening or superimposed edema or infiltrate. Within the mediastinum there are some small but very stable nodes present. There is an excellent bolus and there is no central or mid lung zone pulmonary embolus but peripherally very difficult to identify due to the underlying emphysema and chronic interstitial lung disease. This report was created using Voice Recognition software. Thank you for allowing us to participate in the care of your patient. X-ray chest 1 view [3305321890] Resulted: 10/06/21 0731 Order Status: Completed Updated: 10/06/21 0731 Narrative: XR CHEST 1 VW PORT IMPRESSION: No significant interval change. Redemonstrated diffuse bilateral interstitial markings consistent with pulmonary fibrosis/ILD. Superimposed infection cannot be excluded. Clinical correlation recommended. END OF IMPRESSION: INDICATION: sob. TECHNIQUE: Single AP projection of the chest is acquired. COMPARISON: Chest radiograph from October 5, 2021 and priors FINDINGS: Redemonstrated diffuse bilateral interstitial opacities with a lower lobe predominance, which is more prominent on the left side and not significantly changed compared to prior studies. Opacity at the right lower lung zone is also not significantly changed and likely represents atelectasis. The heart appears borderline enlarged on this single AP projection. The mediastinal contours are unchanged. No large pleural effusion. There is no evidence of pneumothorax. There are no significant bony findings. 10/05/2021 1528 COVID-19 PCR Collected: 10/05/21 1528 | Final result | Specimen: Swab from Nasopharynx 10/06/2021 0734 Respiratory virus detection panel Collected: 10/06/21 0734 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detected Chlamydophila pneumoniae Not Detected Parainfluenza Not Detected COVID-19 SARS-CoV-2 Overall Result Detected Critical Enterovirus/Rhinovirus Not Detected Coronavirus Not Detected Respiratory Syncytial Virus Not Detected Influenza A Not Detected Bordetella pertussis Not Detected Influenza B Not Detected Bordetella parapertussis Not Detected Metapneumovirus Not Detected
CDC Split Type:

Write-up: 91 year old (deceased) Male. Communication details: Call to PCP office to report patient up all night with a cough, elevated temp this morning. Poor appetite today and fatigue. SOB, +DOE, diarrhea. They will call the patient after speaking to the MD. Office Visit Family Medicine Chronic diastolic congestive heart failure +4 more Dx Cough ? Shortness of Breath ? Insomnia ? Poor Appetite Reason for Visit Patient was seen today for cough, shortness of breath, insomnia and poor appetite. Diagnoses and all orders for this visit: Chronic diastolic congestive heart failure - CBC and differential; Future - B-type natriuretic peptide; Future - Basic metabolic panel; Future - X-ray chest 2 views; Future Stage 3a chronic kidney disease - CBC and differential; Future - B-type natriuretic peptide; Future - Basic metabolic panel; Future Suspected COVID-19 virus infection - COVID-19 PCR; Future - COVID-19 PCR Bradycardia - ECG 12-lead: IN OFFICE Patient Instructions I am not entirely sure what is causing your shortness of breath. I think it is going to turn out to be a combination of things. Your pulse is a little bit low. EKG does not show anything that would make me insist upon a pacemaker but you do have an irregular rhythm with some "supraventricular" beats. Chest x-ray Blood work Today when you get home take an extra furosemide 20 mg pill You do not want to go to the emergency department. If you change your mind at any time call 911 Visit time 40 minutes including obtaining history, physical exam, placing orders and, interpreting past test results, communicating to pt/family and dictating. Daughter was a bit frustrated that he did not agree to go to the emergency department. She thought it would be in her dad''s best interest but he strongly and consistently refused emergency department evaluation. He did say that he is dying and his time is limited even if they would elect for hospitalization Return for Next scheduled follow up. Patient is here with wife and daughter due to cough, shortness of breath, decreased appetite. He is known to have interstitial lung disease, COPD, diastolic heart failure, pulmonary hypertension. He was hospitalized a little bit over a week ago for similar symptoms. He was felt to be in heart failure due to an elevated BNP at 503. He was given IV Lasix but that adversely affected his kidney function. He was transitioned and discharged to 20 mg of Lasix daily. He is on chronic oxygen. Since being at home he has not been doing well. He has cough productive of clear sputum, shortness of breath and yesterday he had a fever of 100.6. Yesterday and earlier today when we heard of his difficulties we recommended that he go to the emergency department. He and his wife absolutely refused. They are well aware that emergency department is the most rapid and efficient way of getting testing done. In spite of this they wanted to come into the office to see me today. Patient arrives in a wheelchair. He appears to be in moderate respiratory distress. He appears weak and frail. I confirmed with patient and his wife their desire to return to the hospital. They are again very clear that they do not want emergency department evaluation. They would like for me to do what I can in the outpatient setting. ROS: Patient denies headache, vision changes, chest pain, chest pressure, lightheadedness, dizziness, shortness of breath at rest, nausea, vomiting, melena, bright red blood per rectum, abdominal pain, dysuria, hematuria, focal neurologic deficit, fever, unexplained weight loss ED to Hosp-Admission Discharged 10/6/2021 - 10/10/2021 (4 days) Last attending ? Treatment team Severe sepsis Principal problem Hospital Course:Patient is a 91 y.o. male with past medical history of pulmonary fibrosis and ILD with chronic respiratory failure on home oxygen 2 L per nasal cannula, hypothyroidism, BPH, chronic diastolic heart failure was admitted to Hospital with severe sepsis secondary with associated acute on chronic respiratory failure with hypoxia secondary to COVID-19 pneumonia. He has been undergoing treatment with dexamethasone and Remdesevir for COVID-19 pneumonia. He did receive IV Tocilizumab treatment per ID for worsening acute on chronic respiratory failure with hypoxia requiring maxed out high flow nasal cannula oxygen. He also required empiric antibiotics for possible superimposed community-acquired pneumonia. Over the past 24 hours he developed worsening acute on chronic respiratory failure with hypoxia requiring maxed out high flow nasal cannula oxygen and nonrebreather. The patient also developed worsening acute metabolic encephalopathy and end-stage agitation that did not respond to lorazepam, Zyprexa, or haloperidol. The patient''s breathing and confusion continued to worsen. After further discussion with the patient''s wife, the family has agreed to transition the patient''s goals of care to comfort measures only. The patient was seen by hospice and community care and consents were signed to transition the patient to inpatient hospice. Admission Discharged Acute on chronic respiratory failure with hypoxia Principal problem Details of Hospital Stay Presenting Problem/History of Present Illness/Reason for Admission Acute on chronic respiratory failure with hypoxia Severe sepsis secondary to COVID-19 pneumonia Acute metabolic encephalopathy Patient is a 91 y.o. male with past medical history of pulmonary fibrosis and ILD with chronic respiratory failure on home oxygen 2 L per nasal cannula, hypothyroidism, BPH, chronic diastolic heart failure was admitted to Hospital with severe sepsis secondary with associated acute on chronic respiratory failure with hypoxia secondary to COVID-19 pneumonia. He has been undergoing treatment with dexamethasone and Remdesevir for COVID-19 pneumonia. He did receive IV Tocilizumab treatment per ID for worsening acute on chronic respiratory failure with hypoxia requiring maxed out high flow nasal cannula oxygen. He also required empiric antibiotics for possible superimposed community-acquired pneumonia. Over the past 24 hours he developed worsening acute on chronic respiratory failure with hypoxia requiring maxed out high flow nasal cannula oxygen and nonrebreather. The patient also developed worsening acute metabolic encephalopathy and end-stage agitation that did not respond to lorazepam, Zyprexa, or haloperidol. The patient''s breathing and confusion continued to worsen. After further discussion with the patient''s wife, the family has agreed to transition the patient''s goals of care to comfort measures only. The patient was seen by hospice and community care and consents were signed to transition the patient to inpatient hospice. The patient was readmitted under inpatient hospice. He was started on continuous IV morphine infusion at 2 mg/hr. he did rest comfortably on the morphine drip and passed comfortably in the late afternoon. The family was present at the bedside and were very grateful for the excellent care the patient had received. All of our best wishes were offered to the family at this time. Condition at Discharge Discharge Condition: Expired


VAERS ID: 1787405 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-10-03
Onset:2021-10-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Anaesthetic complication, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: SGMODERNATX, INC.MOD20213

Write-up: He died immediately after being given a topical anesthetic; Died immediately after being given a topical anesthetic following a COVID-19 vaccination; This spontaneous case was reported by a consumer and describes the occurrence of SUDDEN DEATH (He died immediately after being given a topical anesthetic) and ANAESTHETIC COMPLICATION (Died immediately after being given a topical anesthetic following a COVID-19 vaccination) in a male patient of an unknown age who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No Medical History information was reported. On 03-Oct-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) 1 dosage form. On 04-Oct-2021, the patient experienced SUDDEN DEATH (He died immediately after being given a topical anesthetic) (seriousness criteria death and medically significant) and ANAESTHETIC COMPLICATION (Died immediately after being given a topical anesthetic following a COVID-19 vaccination) (seriousness criterion death). The patient died on 04-Oct-2021. The reported cause of death was died immediately after being given a topical anesthetic following a covid-19 vaccination. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. Treatment medication was not provided by the reporter. Reporter was reporting about a message where it was mentioned about, a friend''s relative was vaccinated two days ago and went to the dentist yesterday. He died immediately after being given a topical anesthetic. Company comment This case concerns a male patient, of unknown age, with no relevant medical history, who experienced the unexpected events of anaesthetic complication and sudden death. The events occurred 1 day after administration of a dose of the Moderna COVID-19 Vaccine. The administration of a topical anesthetic remains a confounder. The benefit-risk relationship of the Moderna COVID-19 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a male patient, of unknown age, with no relevant medical history, who experienced the unexpected events of anaesthetic complication and sudden death. The events occurred 1 day after administration of a dose of the Moderna COVID-19 Vaccine. The administration of a topical anesthetic remains a confounder. The benefit-risk relationship of the Moderna COVID-19 Vaccine is not affected by this report.; Reported Cause(s) of Death: Died immediately after being given a topical anesthetic following a COVID-19 vaccination


VAERS ID: 1757635 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-10-02
Onset:2021-10-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Fatigue
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: none
Allergies: unknown
Diagnostic Lab Data:
CDC Split Type:

Write-up: fatigue then death


VAERS ID: 1758695 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-04-08
Onset:2021-10-03
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive, Vaccine breakthrough infection
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: TESTED POSITIVE FOR COVID-19 ON 10/1/2021 (BREAKTHROUGH CASE)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT TESTED POSITIVE FOR COVID-19 ON 10/1/2021 (BREAKTHROUGH CASE); PATIENT EXPIRED ON 10/3/2021


VAERS ID: 1758810 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-02-23
Onset:2021-10-03
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6200 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death, SARS-CoV-2 test positive
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 30 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT TESTED POSITIVE FOR COVID-19 ON 8/27/2021; EXPIRED ON 10/3/2021


VAERS ID: 1759181 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-05-28
Onset:2021-10-03
   Days after vaccination:128
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal wall haematoma, Acute kidney injury, Acute respiratory distress syndrome, Angiogram pulmonary abnormal, Anticoagulant therapy, Anuria, Biopsy cartilage, Blood culture positive, Blood loss anaemia, COVID-19, Chest discomfort, Culture positive, Death, Dyspnoea, Endotracheal intubation, Enterobacter infection, Hepatic failure, Herpes simplex, Intensive care, Metabolic acidosis, Multiple organ dysfunction syndrome, Nasal ulcer, Packed red blood cell transfusion, Pneumonia aspiration, Pulmonary embolism, Respiratory acidosis, SARS-CoV-2 test positive, Serratia infection, Shock, Skin culture positive
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Hypersensitivity (narrow), Myelodysplastic syndrome (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol, Cartia XT, Coreg, Colcrys, Maxidex eye drops, trulicity, Vasotec, metformin, novofine, crestor, xarelto kenalog ointment.
Current Illness:
Preexisting Conditions: OSA, dyslipidemia, right colectomy, eustachian tube dysfunction, homonymous hemianopsia due to cerebrovascular accident, left bundle branch block, chronic anticoagulation, protrusion of intervertebral disc, stenosis of cervical spine, laminectomy.
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fully vaccinated patient admitted for COVID. Provider discharge summary below: "Presented with 8/30 with worsening shortness of breath and chest discomfort following testing positive for COVID-19 on 8/25. He was vaccinated against COVID-19 with the Pfizer series on 5/3 and 5/28. He was admitted and started on oxygen and completed 5 days of remdesivir and a steroid course. Bilateral PE were found on CTA pulm on 9/5/21 and heparin was started. He continued to worsen despite HiFlo and NIPPV. He required intubation and transfer to CCU on 9/13, and started on pressors for support. CCU course was complicated by ARDS, shock, AKI and anuria requiring CRRT (managed by nephology), metabolic acidosis, liver failure, as well as acute blood loss anemia from a rectus sheath bleed causing an abdominal wall hematoma that required 1U pRBC and an abdominal binder. He was found with Serratia odorifera, Enterobacter cloacae on respiratory cultures suggesting aspiration pneumonia. HSV was detected on skin culture. Staph simulans that grew on one blood culture was deemed a contaminant. He received vancomycin, Zosyn, meropenem, metronidazole, acyclovir with antibiotic management guided by Infectious disease. ENT performed a biopsy of an ulcer of his left nare on 9/25, but pathology was pending at time of discharge. Patient did not improve despite treatment and had persistent respiratory acidosis and required maximum vasopressin and norephinephrine support. Palliative care was consulted and the grim prognosis of the patient communicated to family given his multiple organ failure. Patient was switched to comfort care status per family on 10/3/21. Patient died at 3:45 PM on October, 3, 2021."


VAERS ID: 1761541 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-10-03
Onset:2021-10-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039D21A / UNK LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Oxycodone Apap 10-325, Tizanidine 4mg, Gabapentin 300mg, Zolpidem 10mg, Alprazolam 1mg
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: unknown patient representative contacted pharmacy to report the patient had died hours after getting the moderna vaccination


VAERS ID: 1765317 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-30
Onset:2021-10-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FD0809 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multi vitamin
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: My dad had a physical 9/30/2021 and received a clean bill of health complete with lab work. He then received his second covid vaccine. sunday 10/3/2021 my dad got up went to the store..called my mother around noon had lunch and went back to work. two hours later he had an event and DIED. he was In perfect tip top health. he was taken from us way to soon


VAERS ID: 1768241 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-09-30
Onset:2021-10-03
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2588 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death, Injection site erythema, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LOSARTAN 50 MG 1 DAILY, BRILINTA 90MG 1 TWICE DAILY, NITROGLYCERIN 0.4 SUBLINGUAL AS DIRECTED, ISOSORBIDE MONO 30 MG ER 1 IN MORNING, PRALUENT 75MG/MG 75 MG EVERY OTHER WEEK, METOPROLOL TAR 25 MG 1 TWICE DAILY. OTC USE UNKNOWN.
Current Illness: Had undergone a procedure to place stents on 09/27/2021.
Preexisting Conditions: Hyperlipidemia, CAD.
Allergies: STATINS.
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient''s caregiver called us on 10/7/2021 to inform us that patient passed away at 1 am on 10/03/2021 from a heart attack. He had mild redness at the site of injection. No flu like symptoms or fever after receiving the shot.


VAERS ID: 1759418 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-19
Onset:2021-10-02
   Days after vaccination:225
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Intensive care, Positive airway pressure therapy, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin, lipitor, calcium carbonate, Zyrtec, temovate, vitamin B12, Avodart, Ferocon, Flonase, Neurontin, Zestril, Glucophage, Aleve, Saw Palmetto, Flomax, ultram, kenalog cream.
Current Illness:
Preexisting Conditions: Chronic back pain, HTN, DM2, extracranial carotid artery stenosis, arthritis, hyperlipidemia, B12 deficiency, cerebral thrombosis with cerebral infarction, vitiligo, obstructive pattern present on pulmonary function testing, aortic extasia (abdominal), monoclonal gammopathy of unknown significance, spinal stenosis, neuropathy, anemia, history of cerebrovascular accident, benign prostatic hyperplasia.
Allergies: "Seasonal allergies"
Diagnostic Lab Data: COVID positive swab on 09/19/21.
CDC Split Type:

Write-up: Fully COVID vaccinated patient who admitted through emergency department with COVID positive test on 09/19/21. Patients respiratory status continued to decline, he required CCU admission high flow oxygen, and subsquently BiPAP. Medical team reviewed ongoing respiratory decline and grave status with patient and family who declined intubation. Patient moved to comfort care and died on 10/02/21.


VAERS ID: 1760262 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-12
Onset:2021-10-02
   Days after vaccination:204
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6205 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8733 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Asthenia, COVID-19, Chills, Cough, Dyspnoea, Haematochezia, Headache, Myalgia, Oropharyngeal pain, Pneumonia, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal haemorrhage (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: pantoprazole; ibuprofen; HYDROcodone; cholecalciferol; simvastatin; loratadine; flunisolide; metoprolol tartrate;
Current Illness: unknown
Preexisting Conditions: COPD; HTN; dyslipidemia;
Allergies: unknown
Diagnostic Lab Data: 9/18/2021 tested positive for COVID-19 via PCR;
CDC Split Type:

Write-up: 9/18/2021 tested positive for COVID-19 via PCR; developed pneumonia, fever, chills, myalgia, sore throat, headache, cough, dyspnea, abdominal pain, congestion, bloody stool, weakness;


VAERS ID: 1768554 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-10-02
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Hyponatraemia
SMQs:, Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-06
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death E87.1 - Hyponatremia


VAERS ID: 1768564 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-14
Onset:2021-10-02
   Days after vaccination:171
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 002B21A / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 046B21A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute respiratory failure, Death, Hypoxia
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-05
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death J96.90 - Respiratory failure J96.01 - Acute respiratory failure with hypoxia


VAERS ID: 1768576 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-04-23
Onset:2021-10-02
   Days after vaccination:162
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8732 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER8735 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Hyponatraemia
SMQs:, Hyponatraemia/SIADH (narrow), Chronic kidney disease (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death E87.1 - Hyponatremia


VAERS ID: 1771639 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-03-11
Onset:2021-10-02
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 10805029 / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lung Disease, Cardiovascular Disease
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and died due to covid related causes


VAERS ID: 1774920 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Kentucky  
Vaccinated:2021-02-11
Onset:2021-10-02
   Days after vaccination:233
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Blood fibrinogen increased, COVID-19 pneumonia, Cardiac arrest, Death, Epistaxis, International normalised ratio increased, Leukocytosis, Positive airway pressure therapy, Procalcitonin increased, Respiratory failure, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Sepsis (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was admitted to the hospital under a medical service to the COVID-19 unit due to hypoxic respiratory failure secondary to COVID-19 pneumonia. He was started on remdesivir Decadron 6 mg b.i.d. Along with therapeutic dose Lovenox. He was admitted to another unit on BiPAP and pulmonology was consulted. Given his leukocytosis and elevated procalcitonin he was started on cefepime and azithromycin. The patient developed a nose bleed PTT and INR was extremely elevated thus he was given Kcentra and vitamin K. Fibrinogen was high not suggestive of DIC. Overnight the patient cardiac arrested code was called at despite ACLS measures the team was unable to obtain ROSC and resuscitation efforts were discontinued. The patient was pronounced deceased at 0249.


VAERS ID: 1776605 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-10-01
Onset:2021-10-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mirapex, Rytary, Lasix, Lisinopril, Spironolactone, Metoprolol ER, Mag oxide, Coumadin, Vit D3, Atorvastatin, ASA
Current Illness: tooth extraction 1 week prior
Preexisting Conditions: CHF, Afib, Parkinson''s
Allergies: Clindamycin
Diagnostic Lab Data: n/a (saw scheduled regular cardiologist about 1 hour following vaccination - no new issues)
CDC Split Type:

Write-up: death approximately 18 hours following vaccination. Asymptomatic. Died in sleep.


VAERS ID: 1784958 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-04-07
Onset:2021-10-02
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and died due to Covid related causes


VAERS ID: 1785229 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-02-26
Onset:2021-10-02
   Days after vaccination:218
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6202 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Death, Positive airway pressure therapy, SARS-CoV-2 test positive
SMQs:, Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-11
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received dose one as above. Dose 2 (Pfizer lot#ER2613 given IM in left deltoid on 3/19/21. Patient reported to ED on 10/2/21 and tested positive with PCR for covid. Admitted to hospital. During stay, he was placed on steroids, oxygen and bipap. Patient passed on 10/11/21. Patient was DNR/DNI prior to admission


VAERS ID: 1785281 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-04-30
Onset:2021-10-02
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007B21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Chest X-ray abnormal, Chronic obstructive pulmonary disease, Condition aggravated, Death, Endotracheal intubation, Lung opacity, Pneumonia, Positive airway pressure therapy, Pulmonary fibrosis, Septic shock
SMQs:, Angioedema (broad), Interstitial lung disease (narrow), Toxic-septic shock conditions (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-11
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: COPD, CAD, DM, HTN
Allergies: oxycodone
Diagnostic Lab Data: 10/2 Chest x ray showed new basilar opacity superimposed on bibasilar scarring and fibrosis, ,
CDC Split Type:

Write-up: Admitted with adult respiratory distress syndrome, septic shock, pneumonia, COPD . Family chose comfort care instead of aggressive treatments and patient died. Vapotherm, BiPap, intubated, pressors


VAERS ID: 1778554 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-18
Onset:2021-10-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF4204 / 2 LA / OT

Administered by: Other       Purchased by: ?
Symptoms: Cardiac arrest, Cardiac failure
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPPFIZER INC202101303922

Write-up: Cardiac failure; Cardiac arrest; This is a spontaneous report from a contactable physician received via COVID-19 Adverse Event Self-Reporting Solution (COVAES). A 42-year-old male patient received bnt162b2 (COMIRNATY), dose 2 intramuscular, administered in Arm Left, at age 42 years (as reported), on 18Sep2021 12:00 (the day of vaccination) (Batch/Lot Number: FF4204; Expiration Date: 31Oct2021) as DOSE 2, SINGLE for COVID-19 immunisation. The patient had no other medical history. Prior to vaccination, the patient was not diagnosed with COVID-19. The patient had no allergies to medications, food, or other products. The patient''s concomitant medication was none. The patient did not receive any other medications within 2 weeks of vaccination. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient historically received the first dose of COMIRNATY, intramuscular on the arm left, at age 42 years, on 28Aug2021 at 12:00 (Lot number: FF4204, Expiration date 31Oct2021) for COVID-19 immunisation. On 02Oct2021 at 07:00 (also reported as: 14 days after the vaccination), the patient experienced cardiac failure and cardiac arrest. The events resulted in emergency room/department or urgent care, hospitalization in Oct2021 for 1 day, and death. The reported event was as follows: On 02Oct2021, at 07:00 (14 days after the second vaccination), the patient was found to have cardiac arrest in his bed. Although the patient was transferred, he was confirmed to die (due to cardiac failure) in the hospital. It was unknown if treatment was performed. Since the vaccination, it was unknown whether the patient has not been tested for COVID-19. The outcome of the event was fatal. It was unknown if autopsy was performed. The reporting physician assessed the event as serious (death/hospitalization). Cause of death was cardiac failure.; Sender''s Comments: Current information is limited and does not allow a full assessment. No information provided during the period of 14 days after receiving 2nd dose and before events occurrence. Case will be reassessed once receiving additional information. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.; Reported Cause(s) of Death: Cardiac failure


VAERS ID: 1778556 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-18
Onset:2021-10-02
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF4204 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Cardiac failure
SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Result Unstructured Data: Test Result:36.5 Centigrade
CDC Split Type: JPPFIZER INC202101313863

Write-up: Cardiac failure; This is a spontaneous report from a contactable physician. Regulatory authority report number is v21128659. The patient was 42-years-old male. Body temperature before vaccination was 36.5 degrees centigrade. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status). The patient had no family history. On 28Aug2021, the patient previously received the first dose of BNT162b2 (COMIRNATY, Solution for injection, Lot# FF4204, Expiration date 31Oct2021) at DOSE 1, SINGLE for COVID-19 immunisation at the age of 42 years-old. On 18Sep2021 (the day of vaccination), the patient received the second dose of BNT162b2 (COMIRNATY, Solution for injection, Lot number FF4204, Expiration date 31Oct2021) at DOSE 2, SINGLE for COVID-19 immunisation at the age of 42 years-old. In the morning of 02Oct2021 (14 days after the vaccination), the patient experienced cardiac failure and was raced to other hospital but died the same day (reported as admitted and discharged on 02Oct2021). The detailed course of the event was as follows: The patient was a healthy male (42 years old) with no primary disease or allergies at pre-vaccination. On 28Aug2021, adverse reaction was not confirmed after 1st vaccination. On 18Sep2021, 2nd vaccination was performed. In the night of 01Oct2021, the patient went to bed as usual. In the next morning, the patient was found in cardiac arrest, was taken to the emergency room, and was confirmed death (cardiac failure). The reporting physician classified the event as serious (death) and assessed that the causality between the event and BNT162b2 as unknown. Other possible causes of the event such as any other diseases were unknown either. It was not reported if an autopsy was performed, and cause of death. The reporting physician commented as follows: According to Pfizer''s product information, adverse reaction will occur on same day or after several days from the day from vaccination. But this case, onset 14 days after vaccination, was not met to the criteria.; Reported Cause(s) of Death: Cardiac failure


VAERS ID: 1754103 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0202 / 3 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ749AA / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 08/04/2021 Jublia 10 % topical solution with applicator 1 application apply to nails daily; cover affected toenail, toenail folds, toenail bed and undersurface of nail x 48 weeks. 07/27/2021 Invokana 100 mg tablet 1 tablet by mouth daily 07
Current Illness: none noted
Preexisting Conditions: E1165 Type 2 Diabetes Mellitus With Hyperglycemia N183 Chronic Kidney Disease, Stage 3 (moderate) E291 Testicular Hypofunction E782 Mixed Hyperlipidemia M5417 Radiculopathy, Lumbosacral Region Sleep Apnea I714 Abdominal Aortic Aneurysm, Without Rupture
Allergies: NKDA
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Received call this morning 10/1/2021 from medical examiner that wife found patient deacesed - medical examiner states that he determinded natural causes.


VAERS ID: 1768588 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-03-10
Onset:2021-10-01
   Days after vaccination:205
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / UNK - / -
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6208 / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute respiratory failure, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-03
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death N17.9 - AKI (acute kidney injury) (CMS/HCC) J96.01 - Acute respiratory failure with hypoxia (CMS/HCC)


VAERS ID: 1775309 (history)  
Form: Version 2.0  
Age: 98.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-09-27
Onset:2021-10-01
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 3 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chest X-ray, Death, Respiratory arrest, White blood cell count
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-10-02
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Melatonin 1mg Hytrin
Current Illness: Delirium Decubitus Open head wound as a result of necrotizing fasciitis
Preexisting Conditions: Hypertension
Allergies: Penicillin
Diagnostic Lab Data: Cxr Wbc
CDC Split Type:

Write-up: Respiratory arrest Death


VAERS ID: 1776387 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-23
Onset:2021-10-01
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 30155BA / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, SARS-CoV-2 test negative, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Glipizide, Vit D-3, Fish Oil, Victoza, Losartan, Metformin, Vit B-12. Jardiance
Current Illness: None
Preexisting Conditions: Diabetes HTN Hyperlipidemia
Allergies: Bees
Diagnostic Lab Data: CoVid test negative.
CDC Split Type:

Write-up: Found unresponsive after coworker heard a thud. Code Blue called. CPR initiated, AED applied and no shockable rhythm x3. Code continued for 45 minutes with paramedics on scene and drugs administered. Time of death called by ER physician on phone.


VAERS ID: 1783092 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-09-28
Onset:2021-10-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0191 / 3 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, Pulmonary embolism, Resuscitation, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-13
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: escitalopram, atomoxetine, norethindrone-ethinyl estradiol, ondansetron, omeprazole
Current Illness:
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt presented to the ED 10/13 with syncope and what appeared to be a pulmonary embolism. Tried to resuscitate patient for 90 minutes but no success.


VAERS ID: 1783819 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-06
Onset:2021-10-01
   Days after vaccination:178
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / UNK - / -

Administered by: Public       Purchased by: ?
Symptoms: COVID-19, Death
SMQs:, Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, Renal disease, high blood pressure
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient fully vaccinated and died due to Covid related causes


VAERS ID: 1785167 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-14
Onset:2021-10-01
   Days after vaccination:170
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025B21A / 2 - / IM

Administered by: Public       Purchased by: ?
Symptoms: Death, General physical health deterioration, Intensive care
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-12
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Diabetes CAD Former smoker
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Was admitted 9/28/2021 to 10/1/2021 received 3 doses of Remdesivir. Pt was readmitted 10/6/2021 where he progressively worsened, pt was in ICU. Pt then put into hospice care and passed away 10/12/2021 at 1949


VAERS ID: 1785490 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-11
Onset:2021-10-01
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram abnormal, COVID-19, Cardiac disorder, Carotid artery occlusion, Cerebrovascular accident, Chest X-ray normal, Computerised tomogram abnormal, Death, Embolism venous, Endotracheal intubation, Haemodynamic instability, Haemoglobin normal, Hemiparesis, Hypoxia, Nucleic acid test, Pulseless electrical activity, SARS-CoV-2 test positive, Sepsis, Thrombectomy, Troponin increased, Ultrasound Doppler, White blood cell count increased
SMQs:, Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-11
   Days after onset: 10
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol Nebulizer PRN, Carvedilol 6.25 mg BID, Escitalopram 20 mg QD, Furosemide 40 mg BID, Glipizide 10 mg BID, Hydroxyzine 25 mg Q8H PRN Anxiety, Insulin NPH 65 units QAM and 20 units QPM, Potassium chloride 10 mEq QD, Simvastatin 10 mg
Current Illness:
Preexisting Conditions: Acute Otitis Media, ANxiety, CAD, Cataracts, CHF, CKD, COPD, DM, Enlarged thyroid, Hypertension, Sleep apnea, Vitamin D deficiency
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Positive test on 10/1/2021 using the Roche LIAT SARS assay platform using PCR or equivalent Nucleic Acid Amplification (NAA) technology.
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine EUA: Patient received Janssen Vaccine on 4/11/2021. On 10/1/2021, patient presented to Medical Center with a chief complaint of cerebrovascular accident. Symptom onset was overnight and patient woke with complaints of left sided weakness. He was seen by teleneurology and CTA showed occlusion at the right ICA origin. CT perfusion scan revealed at risk tissue that was felt to be amenable to reperfusion, so pt was transferred to Hospital emergently for cerebral thrombectomy. He was intubated for procedure. Of note he is Covid positive. Patient was extubated after procedure on 10/1. Patient was reintubated on 10/7. He developed acute hemodynamic instability and worsening hypoxemia on 10/11/2021. Etiology was unclear: acute sepsis vs cardiac event vs venous thromboembolic disease. WBC acutely elevated. CXR stable. LE dopplers (-). Troponin 0.14-- $g0.15. Hb stable. He progressed to PEA arrest and did not have ROSC despite ACLS. Patient passed away on 10/11/2021.


VAERS ID: 1785494 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-04-29
Onset:2021-10-01
   Days after vaccination:155
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Acute respiratory failure, Asthenia, Atrial fibrillation, Blood glucose decreased, COVID-19, COVID-19 pneumonia, Chest X-ray abnormal, Cough, Death, Decreased appetite, Diarrhoea, Endotracheal intubation, Lung infiltration, Multiple organ dysfunction syndrome, SARS-CoV-2 test positive, Septic shock, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (narrow), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-08
   Days after onset: 7
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg Q6H prn, Albuterol Nebs PRN, Alprazolam, 0.25 mg BID, Apixaban 5 mg BID, Cetirizine 10 mg QD, Furosemide 40 mg QD PRN, Gabapentin 300 mg QAM and QPM - 600 mg QHS, Hydroxychloroquine 200 mg BID, Magnesium Oxide 400 mg QD
Current Illness:
Preexisting Conditions: Atrial fibrillation, Hypertension, S/P Pacemaker, Sick Sinus Syndrome, Rheumatoid arthritis, Acute on Chronic CHF, with preserved ejection fraction (HFpEF), Cirrhosis
Allergies: Celecoxib, Diflunisal, Ibuprofen, Penicillin
Diagnostic Lab Data: Positive COVID-19 Test on 10/1/2021 using the Roche LIAT SARS assay platform using PCR or equivalent Nucleic Acid Amplification (NAA) technology. CXR = bilateral infiltrates
CDC Split Type:

Write-up: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 4/8/2021 and 4/29/2021. Presented to ED on 10/1/2021 with low blood sugar (25 per EMS arrival and 31 on arrival), generalized weakness, and a decreased appetite. Around 7AM son tried to wake her up but she was unresponsive prompting EMS activation. Patient reports weakness for about two weeks, cough for approximately one week with diarrhea. Patient completed 5 days of Remdesivir, also treated with Dexamethasone. Patient required intubation on 10/8. Patient progressed to shock, A-fib with RVR, COVID, and possible UTI and maxed out on three pressors. Family requested to switch to comfort care. Patient expired on 10/8/2021 with cause of death documented in chart as Septic shock with MOD & acute hypoxic respiratory failure 2/2 Covid PNA.


VAERS ID: 1784362 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-01
Onset:2021-10-01
   Days after vaccination:92
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Cerebrovascular accident
SMQs:, Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPPFIZER INC202101311874

Write-up: suspected stroke; This is a spontaneous report from a contactable physician. A 65-year-old male patient received the second single dose of COVID-19 Vaccine (Manufacturer Unknown, Batch/Lot number was not reported) intramuscularly on an unspecified date at end of Jul2021 for COVID-19 immunisation. The patient''s medical history and concomitant medications were not reported. Historical vaccine included first single dose COVID-19 Vaccine (Manufacturer Unknown, Batch/Lot number was not reported) via unspecified route of administration on an unspecified date for COVID-19 immunisation. On 01Oct2021 (unknown months and days after the vaccination), the patient experienced suspected stroke. The outcome was fatal. Death date was 01Oct2021. The course of the event was as follows: On 01Oct2021, a contact was received from the patient''s family that the patient was found dead while taking a bath. The reporting physician confirmed her death. The reporting physician stated that, in light of the status, the possibility of stroke was considered to be high. The reporting physician was informed by the patient''s family that she received the second dose of COVID-19 vaccine at the end of Jul2021. However, it was determined that there was no causality between the vaccination and the event. (As for COVID-19 vaccine, it was not clarified which manufacturer''s vaccine the patient received). There was probably no causality, and the vaccine might not be Comirnaty, but this information was given to be safe. The reporting physician classified the event as serious (death) and assessed that the event was unrelated to BNT162b2. It was not reported if an autopsy was performed. On 04Oct2021, the same contactable physician reported the following: The reporting physician was not the patient''s primary care physician. The patient died in the bathroom on 01Oct2021. At the request of the Police, this was to be a case of postmortem examination requiring an autopsy. Although it was not confirmed whether a manufacturer was Pfizer, the reporting physician thought that the vaccine was probably made by Pfizer because the patient had been seen by another clinic''s physician. The patient''s family doubted the vaccine as the cause of his death. It was impossible that the patient died of adverse reactions to the vaccine 2 months or more after the vaccination, so this case was submitted as the death from disease in the post-mortem certificate. Examinations such as blood testing could not be conducted, since the patient had already died. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.; Sender''s Comments: Based on known drug safety profile, there is reasonable possibility of causal association between the event Cerebrovascular accident (Fatal) and BNT162B2. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Suspected Stroke


VAERS ID: 1784390 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-10-03
Onset:2021-10-01
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / 2 - / OT

Administered by: Other       Purchased by: ?
Symptoms: Pyrexia, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hepatic steatosis
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPPFIZER INC202101334882

Write-up: Pyrexia; Sudden death; This is a spontaneous report from a non-contactable consumer. A 34-year-old male patient received the second single dose of COVID-19 Vaccine (Manufacturer Unknown) at age of 34-year-old intramuscularly on 03Oct2021 at dose 2, 0.3 ml single for COVID-19 immunisation. Medical history included hepatic steatosis. The patient''s concomitant medications were not reported. The patient previously received 1st dose of COVID-19 Vaccine for COVID-19 immunisation. On an unknown date (unknown days after the vaccination), the patient experienced pyrexia. Between 05Oct2021 at night and 06Oct2021 in the morning (2 to 3 days after the vaccination), the patient experienced sudden death. The outcome was fatal. The course of the event was as follows: On 03Oct2021, the patient received the second dose of COVID-19 Vaccine (whether it was Comirnaty or another company''s vaccine was unknown). On 05Oct2021, the patient went to the office. On 06Oct2021 in the morning, the patient''s mother, who lived with him, found that he was dead. The patient died between 05Oct2021 at night and 06Oct2021 in the morning. Afterward, the patient was transported to a hospital. He had also developed pyrexia, but the details including the timing were unknown. The event was reported as serious (death). Causality was not reported. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Sudden death


VAERS ID: 1784421 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-10-01
Onset:2021-10-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3005694 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Malaise, Oropharyngeal pain, Pericardial haemorrhage, Sudden death
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Cardiomyopathy (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: JPMODERNATX, INC.MOD20213

Write-up: Sudden death; Haemopericardium due to left ventricular rupture; Sore throat; Malaise; Shoulder pain; This case was received via Regulatory Authority (Reference number: JP-TAKEDA-2021TJP101755) on 06-Oct-2021 and was forwarded to Moderna on 07-Oct-2021. This case, initially reported by a physician, was received (Ref,v21129727). On an unknown date, body temperature before the vaccination: 36.4 degrees Celsius. On 01-Oct-2021, at 13:45, the patient received the 1st dose of this vaccine. Malaise and left shoulder pain developed. On 02-Oct-2021, malaise and left shoulder pain developed. On 03-Oct-2021, in the evening, the patient complained of sore throat, right shoulder pain, and malaise. On 04-Oct-2021, at around 07:00, the patient fell at home complaining of chest discomfort. The patient was raced to a hospital but was confirmed dead at the hospital. The cause of death of the corpse was considered as haemopericardium caused by left ventricular rupture. The outcome of malaise, shoulder pain, sore throat, and haemopericardium due to left ventricular rupture was reported as fatal. Follow-up investigation will be made. Company Comment: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter''s Comments: A 44-year-old male patient with no clear medical history died suddenly 3 days after the vaccination with this vaccine. The effect of adverse reactions is unknown. The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Sender''s Comments: This case concerns a 44-year-old, male subject, with no relevant medical history who experienced the serious, fatal event of pericardial hemorrhage, among others. The events occurred approximately 4 days after the first dose of Spikevax. The rechallenge was not applicable as the patient did not receive a second dose. Causality was assessed as possible per the reporter. The benefit-risk relationship of the vaccine is not affected by this report. Event seriousness assessed as per Regulatory Authority reporting.; Reported Cause(s) of Death: Malaise; Shoulder pain; Pharyngodynia; Haemopericardium; Sudden death


VAERS ID: 1787063 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-30
Onset:2021-10-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 083F21B / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, Body temperature, Cardiac arrest, Cerebrovascular accident, Heart rate, Hypertension, Neurogenic shock, Oxygen saturation, Respiratory rate, SARS-CoV-2 test
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Blood pressure; Result Unstructured Data: high; Test Name: body temperature; Result Unstructured Data: low; Test Name: heart rate; Result Unstructured Data: high; Test Name: O2; Result Unstructured Data: normal; Test Name: respiratory rate; Result Unstructured Data: high; Test Date: 20211001; Test Name: COVID-19 RT PCR; Test Result: Negative ; Result Unstructured Data: negative; Test Date: 20211002; Test Name: COVID-19 RT PCR; Test Result: Negative ; Result Unstructured Data: negative
CDC Split Type: PHMODERNATX, INC.MOD20213

Write-up: hypertension stage 2; Cerebrovascular Accident bleed; Cardio Pulmunary Arrest; Neurogenic shock secondary; This spontaneous case was reported by a consumer and describes the occurrence of CEREBROVASCULAR ACCIDENT (Cerebrovascular Accident bleed), CARDIAC ARREST (Cardio Pulmunary Arrest), NEUROGENIC SHOCK (Neurogenic shock secondary) and HYPERTENSION (hypertension stage 2) in a 37-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no. 083F21B) for COVID-19 vaccination. No Medical History information was reported. On 30-Sep-2021, the patient received first dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 100 mcg. On 01-Oct-2021, the patient experienced CEREBROVASCULAR ACCIDENT (Cerebrovascular Accident bleed) (seriousness criteria death, hospitalization and medically significant), CARDIAC ARREST (Cardio Pulmunary Arrest) (seriousness criteria death, hospitalization and medically significant) and NEUROGENIC SHOCK (Neurogenic shock secondary) (seriousness criteria death, hospitalization and medically significant). On an unknown date, the patient experienced HYPERTENSION (hypertension stage 2) (seriousness criteria death and hospitalization). The patient was hospitalized from 01-Oct-2021 to 03-Oct-2021 due to CARDIAC ARREST, CEREBROVASCULAR ACCIDENT and NEUROGENIC SHOCK, and then from 01-Oct-2021 to sometime in October 2021 due to HYPERTENSION. The patient was treated with MANNITOL (intravenous) at a dose of 200 ml, 150 cc Q6HOURS; NICARDIPINE at a dose of 110 mg+90CC PNSS TO RUN AT 10UGTTS/MIN,INCREASE IN INCREMENTS OF 5 UGTTS/MIN Q4HOURS TO ACHIA A BP LESS THAN OR EQUAL TO 140/90,THEN START TO DECREASE IN INCREMENTS OF 5UGTT/MIN Q4 HOURS TO MAINTAIN A STABLE BP OF LESSTHAN OR EQUAL TO 140/90; ATORVASTATIN at a dose of 80 mg OD AT CIA NGT; LOSARTAN at a dose of 100 mg OD AT 6AM; PARACETAMOL (intravenous) for Fever, at a dose of 300 mg IVTT Q12HOURS and CITICOLINE (CITICHOLINE [CITICOLINE]) (intravenous) at a dose of 1 gram IVTT Q12 HOURS. The reported cause of death was cerebrovascular accident bleed, Cardiac arrest, hypertension stage 2 and neurogenic shock secondary. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 01-Oct-2021, SARS-CoV-2 test: negative (Negative) negative. On 02-Oct-2021, SARS-CoV-2 test: negative (Negative) negative. On an unknown date, Blood pressure measurement: 150/90 (High) high. On an unknown date, Body temperature: 36.6 (Low) low. On an unknown date, Heart rate: 103 (High) high. On an unknown date, Oxygen saturation: 96% (normal) normal. On an unknown date, Respiratory rate: 19 (High) high. No Concomitant medication were provided Serum Electrolytes (Na, K, Ca) with unknown results, DX-RAT, 12L-ECG, CXR-APL, PLAIN CRANIAL,CT SCAN, CBC-PC,UA, RBS NOW, FBS, LIPID PROFILE, CREATININE, provided with unknown results. Patient age given as 36 years, height 5.2 cm. IVF PNSS 1 L AT KVO Patient was inserted the NGT for feeding, O2 inhalation at 2 LPM via Nasal Cannula I and O Q Shift Company comment: This case concerns a 37 year-old male patient with no reported medical history who experienced the unexpected events of cerebrovascular accident bleed, cardiac arrest, which are AESIs, neurogenic shock, and hypertension. The event cerebrovascular accident bleed, neurogenic shock and cardiac arrest occurred approximately 1 day after the first dose of mRNA-1273 (Spikevax) and had a fatal outcome, with death occurring approximately 3 days afterwards. The rechallenge was not applicable due to death. The benefit-risk relationship of mRNA-1273 (Spikevax) is not affected by this report.; Sender''s Comments: This case concerns a 37 year-old male patient with no reported medical history who experienced the unexpected events of cerebrovascular accident bleed, cardiac arrest, which are AESIs, neurogenic shock, and hypertension. The event cerebrovascular accident bleed, neurogenic shock and cardiac arrest occurred approximately 1 day after the first dose of mRNA-1273 (Spikevax) and had a fatal outcome, with death occurring approximately 3 days afterwards. The rechallenge was not applicable due to death. The benefit-risk relationship of mRNA-1273 (Spikevax) is not affected by this report.; Reported Cause(s) of Death: Cerebrovascular Accident bleed; Cardiac arrest; hypertension stage 2; Neurogenic shock secondary


VAERS ID: 1749656 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2021-05-17
Onset:2021-09-30
   Days after vaccination:136
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 2 - / -

Administered by: Public       Purchased by: ?
Symptoms: Adenocarcinoma, Condition aggravated, Death
SMQs:, Non-haematological malignant tumours (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: End stage pancreatic adenocarcinoma- on hospice
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Dose 1 04/22/2021 Lot # EW0172 Pfizer Pt died on 9/30/2021 in the ED from complications with her end stage adenocarcinoma. This was not a Covid illness related death


VAERS ID: 1754274 (history)  
Form: Version 2.0  
Age: 83.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Aspirin Tablet 81 MG, Famotidine Tablet 20 MG, Pravastatin Sodium Tablet 10 MG, Toprol XL Tablet Extended Release 24 Hour 25 MG (Metoprolol Succinate ER), colace Capsule 100 MG, Vitamin C Tablet 500 MG, Advair Diskus Aerosol Powder Breath A
Current Illness:
Preexisting Conditions: CHRONIC OBSTRUCTIVE PULMONARY DISEASE, TYPE 2 DIABETES MELLITUS, INTERSTITIAL PULMONARY DISEASE, PULMONARY HYPERTENSION, HEART FAILURE, ATHEROSCLEROTIC HEART DISEASE, ESSENTIAL (PRIMARY) HYPERTENSION, HYPERLIPIDEMIA, GASTRO-ESOPHAGEAL REFLUX DISEASE, EDEMA, COUGH, ANGINA PECTORIS, DYSPHAGIA, PRESENCE OF CARDIAC PACEMAKER, MAJOR DEPRESSIVE DISORDER, RECURRENT SEVERE WITHOUT PSYCHOTIC FEATURES, SUBSEQUENT NON-ST ELEVATION (NSTEMI) MYOCARDIAL INFARCTION, DEPENDENCE ON SUPPLEMENTAL OXYGEN
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: death, 0 signs/ symptoms noted,


VAERS ID: 1754275 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-04
Onset:2021-09-30
   Days after vaccination:118
Submitted: 0000-00-00
Entered: 2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 1768620 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-20
Onset:2021-09-30
   Days after vaccination:222
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: death Acute kidney injury


VAERS ID: 1769681 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-03-12
Onset:2021-09-30
   Days after vaccination:202
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute respiratory failure, COVID-19, COVID-19 pneumonia, Condition aggravated, Death, Hyperglycaemia, Hyponatraemia, Hypoxia, Intensive care, Oxygen saturation decreased, Pneumonia bacterial, Superinfection, Type 2 diabetes mellitus
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hyponatraemia/SIADH (narrow), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-04
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine (NORVASC) 5 MG tablet ascorbic acid (VITAMIN C) 500 MG tablet aspirin 81 MG chewable tablet busPIRone (BUSPAR) 5 MG tablet Cholecalciferol (VITAMIN D3) 1000 UNITS TABS Cyanocobalamin (VITAMIN B 12) 500 MCG TABS escitalopram (LEXA
Current Illness: NA
Preexisting Conditions: Diabetes mellitus type 2, uncontrolled Depression Vitamin D deficiency Osteoporosis, unspecified OA (osteoarthritis) Hypothyroid Varicose veins of lower extremities Fatigue Anxiety OSA on CPAP Periodic limb movements of sleep Diabetic neuropathy Coronary artery disease of native artery of native heart with stable angina pectoris Anemia Essential hypertension Sleep disturbance Gout of left foot, unspecified cause, unspecified chronicity Asthma Thoracogenic scoliosis of thoracic region Chronic kidney disease, stage 4 (severe) Class 2 severe obesity due to excess calories with serious comorbidity and body mass index (BMI) of 39.0 to 39.9 in adult Renal oncocytoma of left kidney Lower extremity edema Diabetic ulcer of toe of left foot associated with type 2 diabetes mellitus, with fat layer exposed PAD (peripheral artery disease) Rash COVID-19
Allergies: Brilinta [Ticagrelor] Statins
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deceased (10.4.21); Hospitalized (9.30.21); COVID-19 positive (9.30.21); fully vaccinated Discharge Provider: MD Primary Care Physician at Discharge: None Physician, MD None Admission Date: 9/30/2021 Date of Death: 10/4/21 Time of Death: 12:50 PM Preliminary Cause of Death: Acute respiratory failure due to COVID-19 PRESENTING PROBLEM: Hyponatremia [E87.1] Type 2 diabetes mellitus with hyperglycemia, without long-term current use of insulin [E11.65] COVID-19 [U07.1] Acute respiratory failure due to COVID-19 [U07.1, J96.00] Acute hypoxemic respiratory failure [J96.01] HOSPITAL COURSE: Patient admitted for acute hypoxic respiratory failure due to COVID-19 pneumonia. Patient was fully vaccinated, however she did not respond well to maximum medical therapy including iV decadron, IV remdesivir, and broad spectrum antibiotics to cover superimposed bacterial pneumonia. She was transferred to the ICU on maximum HFNC. She continued to have low oxygen levels. Patient decompensated and after long discussion with the family, resulted in transition to comfort care. She expired comfortably surrounded by family at 1250 on 10/4/21.


VAERS ID: 1779581 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: California  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2589 / 2 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Autopsy, Death, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Fever sore arm.
Other Medications: Tylenol
Current Illness: None
Preexisting Conditions: None
Allergies: Sulpha drugs
Diagnostic Lab Data: Autopsy performed by local Coroners Office.
CDC Split Type:

Write-up: Woke up with a fever of 99.4. When I checked on her in the evening she was dead.


VAERS ID: 1782821 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-03-31
Onset:2021-09-30
   Days after vaccination:183
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 1 - / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Cyanosis, Diarrhoea, Dyspnoea, Endotracheal intubation, Feeling hot, Hyperhidrosis, Nausea, Paranasal sinus discomfort, Posture abnormal, Respiratory symptom, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Pseudomembranous colitis (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Loratadine, metformin, sitagliptin, simvastatin, losartan, metoprolol tartrate, calcium w/vitamin D, cinnamon bark, montelukast, fenofibrate, multivitamin w/minerals, multivitamin-iron-folic acid, fluticasone nasal spray, aspirin, tizanidin
Current Illness: none
Preexisting Conditions: Chronic low back pain Diabetes type 2 migraines hypertension mixed hyperlipidemia seasonal allergies
Allergies: meperidine - hives/swelling morphine - hives/swelling
Diagnostic Lab Data:
CDC Split Type:

Write-up: Presented to hospital after being unresponsive at home. Patient began having upper respiratory symptoms on the Sunday prior to admission with frontal sinus pressure. Began having diarrhea the day prior to admission. Day of admission patient was found to be nauseous, hot, profusely sweating and short of breath on the toilet. While on the toilet patient went unresponsive, slumped over, lips turned blue and EMS was called. Patient was intubated upon admission to the ER.


VAERS ID: 1782933 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301258A / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRAMADOL,ESCITALOPRAM,ATORVASTATIN,AMLODIPINE,METOPROLOL
Current Illness:
Preexisting Conditions: HTN, RENAL FAILURE, LEUKOCYTOSIS, HYPOTHYROIDISM, HYPOKALEMIA, ATHERSCLEROTIC DISEASE, POSSTROKE APHASIA
Allergies: NIACIN, PENICILLAMINE
Diagnostic Lab Data:
CDC Split Type:

Write-up: DEATH


VAERS ID: 1773200 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF4204 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute respiratory distress syndrome, Blood pressure measurement, Body temperature, Computerised tomogram, Investigation, Oxygen saturation, Pneumonia aspiration, Volvulus
SMQs:, Interstitial lung disease (broad), Gastrointestinal obstruction (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-10-01
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LIXIANA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Atrial fibrillation; Gastrostomy (for Parkinson''s disease); Nasogastric tube feeding; Parkinson''s disease; Urinary tract infection
Allergies:
Diagnostic Lab Data: Test Date: 20210930; Test Name: blood pressure; Result Unstructured Data: Test Result:decreased; Test Date: 20210929; Test Name: Body temperature; Result Unstructured Data: Test Result:37.2 Centigrade; Comments: before vaccination; Test Name: Abdominal CT scan; Result Unstructured Data: Test Result:sigmoid volvulus; Test Name: Detailed examination after gastrostomy; Result Unstructured Data: Test Result:no abnormalities in the abdomen; Comments: no abnormalities in the abdomen; Test Date: 20210930; Test Name: amount of oxygen in the blood; Result Unstructured Data: Test Result:acutely decreased
CDC Split Type: JPPFIZER INC202101311717

Write-up: Sigmoid volvulus; Acute respiratory distress syndrome accompanied by pneumonia aspiration; pneumonia aspiration suspected; This is a spontaneous report from a contactable physician received from the Regulatory authority. Regulatory authority report number is v21128613. An 83-year-old male patient received bnt162b2 (COMIRNATY), via an unspecified route of administration on 29Sep2021 14:35 (Lot Number: FF4204; Expiration Date: 31Oct2021) as second dose, single for covid-19 immunisation. Medical history included atrial fibrillation, Parkinson''s disease, urinary tract infection, gastrostomy (for Parkinson''s disease), tube feeding. Concomitant medication included ongoing edoxaban tosilate (LIXIANA). The patient previously took bnt162b2 (COMIRNATY), on unspecified date (Lot Number: not reported) as first dose, single for covid-19 immunisation and experienced slight fever. On 30Sep2021 01:30, the patient experienced sigmoid volvulus. On 30Sep2021, the patient experienced acute respiratory distress syndrome accompanied by pneumonia aspiration. The patient underwent lab tests and procedures which included body temperature of 37.2 degrees centigrade on 29Sep2021 before vaccination. Therapeutic measures were taken as a result of all the events. The patient died on 01Oct2021 due to sigmoid volvulus and acute respiratory distress syndrome accompanied by pneumonia aspiration. It was not reported if an autopsy was performed. The course of the events was as follows: Detailed examination after gastrostomy for Parkinson''s disease showed no abnormalities in the abdomen. About 10 hours after the second dose of the vaccination (on 30Sep2021), the patient complained of abdominal pain/nausea, and vomiting were also noted. After vomiting, nausea subsided, but amount of oxygen in the blood was acutely decreased, and pneumonia aspiration was suspected. Afterward, decreased blood pressure occurred. Acute respiratory distress syndrome accompanied by pneumonia aspiration was suspected. Abdominal CT scan showed sigmoid volvulus. Surgery treatment was difficult to be performed, therefore, administration of antibiotics and vasopressor, and oxygen administration were performed, but they did not work. On 01Oct2021 at 18:34, the patient''s death was confirmed. The reporting physician classified the event sigmoid volvulus as serious (fatal outcome) and assessed that the event was related to BNT162b2. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: The cause of death was considered to be ARDS (acute respiratory distress syndrome), but there were no signs of sigmoid volvulus which triggered ARDS to occur. The patient had been free from any troubles due to tubal feeding. Ten hours after the vaccination, the event occurred. Given those facts, it was considered that there was a causal relationship with the vaccination.; Reported Cause(s) of Death: Acute respiratory distress syndrome accompanied by pneumonia aspiration; Sigmoid volvulus; Acute respiratory distress syndrome accompanied by pneumonia aspiration


VAERS ID: 1778560 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-28
Onset:2021-09-30
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FG0978 / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: Acute myocardial infarction, Blood pressure measurement, Body temperature, Heart rate, Investigation
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-30
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Aortic aneurysm rupture; Left sided paralysis; Orientation disturbed; Short-term memory impairment; Spatial disorientation (Left side); Subarachnoid haemorrhage
Allergies:
Diagnostic Lab Data: Test Date: 20210930; Test Name: blood pressure; Result Unstructured Data: Test Result:80s; Comments: on palpation; Test Date: 20210928; Test Name: body temperature; Result Unstructured Data: Test Result:36.5 Centigrade; Comments: Before vaccination; Test Date: 20210930; Test Name: tachycardia; Result Unstructured Data: Test Result:80s; Test Date: 20210930; Test Name: SAT; Test Result: 86 %
CDC Split Type: JPPFIZER INC202101319474

Write-up: Acute myocardial infarction; This is a spontaneous report from a contactable physician received from the RA and a pharmacist. The regulatory authority report number is v21128744. A 72-year and 11-month-old female patient received the second dose of BNT162b2 (COMIRNATY, solution for injection, Lot number: FG0978, Expiration Date: 30Nov2021) via an unspecified route of administration at single dose on 28Sep2021 at 10:36 at the age of 72-year-old for COVID-19 immunization. Body temperature before vaccination was 36.5 degrees centigrade on 28Sep2021. The first dose was on an unspecified date in 2021. Medical history included subarachnoid haemorrhage from 28Jun2021; rupture of right middle aortic aneurysm from 28Jun2021; left sided paralysis; left side spatial disorientation; orientation disturbed; short-term memory impairment. The family history was not provided. Concomitant medication was not reported. On 30Sep2021 at 13:46 (2 days 3 hrs 10 min after the vaccination), the patient experienced acute myocardial infarction. The course of the event was as follows: On 28Jun2021, a clipping surgery was performed for subarachnoid haemorrhage and right middle cerebral artery aneurysm ruptured which occurred on the same day. After the surgery, mild paralysis of left upper and lower limbs, left sided spatial agnosia, disorientation, and decreased memory persisted. On 04Aug2021, the patient was transferred to the convalescent rehabilitation ward. On 30Sep2021 (one day, 13 hours, and 24 minutes after vaccination), the general condition was favorable until lunch, and the patient could take 100% of lunch. On the same day, at 13:45 (2 days, 3 hours, and 9 minutes after vaccination), since the patient complained of malaise while she was seated in a wheelchair in the day room, she moved to her room. Although the patient could walk approximately 50 m with moderate help until morning on the same day, she could not stand up at that time. As soon as the patient lay down in the bed, she had pallor facial and stertor. The blood pressure was 80s on palpation, the tachycardia was 80s, and the SAT was 86%. No pupil unequal was noted, and the consciousness level was Coma Scale 100. Thus, immediately an intravenous line was established, and the patient was transferred to the general ward. The pressure rising with dopamine and adrenaline was ineffective, and the patient was confirmed to die at 15:37 on 30Sep2021 (2 days after the vaccination). Autopsy was not performed. The outcome of event was fatal. The reporting physician classified the event as serious (death) and assessed that the causality between the event and BNT162B2 as unassessable. There was no other possible cause of the event such as any other diseases. The reporting physician commented as follows: The onset date of the event was 2 days after the BNT162B2 vaccination, and 3 months had passed since the surgery for subarachnoid haemorrhage, and the patient was a 72-year-old female with favorable general condition. In the explanation that sudden cardiogenic shock was considerable, the causality between the event and the vaccination was considered, which required a report.; Reported Cause(s) of Death: Acute myocardial infarction


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